Table 1.
Suggested Strategy of Care According to Either TSH Value or the Patient Clinical Features
| Serum TSH Valuea | Fit Patient | Frail Patient | ||
|---|---|---|---|---|
| 65–75 Y | >75 Y | 65–75 Y | >75 Y | |
| >10 mIU/L | Treatb | Treatc/observe | Observe/treatc | Observe |
| 6–10 mIU/L | Observe/treatc,d | Observe/treatc,d | Observe | Observe |
| 4–6 mIU/L | Observe/treatc,d | Observe | Observe | Observe |
a
Elevation of serum TSH value should be confirmed by at least a second measurement at 3- to 6-mo follow-up.
b
l-T4 dosage starting from 0.3 to 0.4 µg/kg/d; increments by 10% to 15% after 6 to 8 wk, if necessary. Optimal TSH target value for patients >75 y receiving l-T4 therapy: 2.5 to 3.5 mIU/L.
c
In the presence of positive antithyroid autoantibody titres, symptoms of hypothyroidism, concomitant diseases potentially impaired by mild thyroid failure (i.e., HF), also according to patients’ willing.
d
In the case of progressive increase of serum TSH value up to ≥10 mIU/L.