Non-medicalization of medical science: Rationalization for future

Table 2 Guideline recommendations for treatment of subclinical hypothyroidism

Degree of subclinical hypothyroidism	ATA 2012[36]	ETA 2013[37]	NICE 2019[38]
TSH > 10 mIU/L	Levothyroxine should be considered. (Grade B)	Younger patients (< 65 to 70 yr): Treatment with levothyroxine is recommended, even in the absence of symptoms. (Grade 2); Older patients (> 70 yr): Treatment with levothyroxine should be considered if clear symptoms of hypothyroidism are present or if the risk of vascular events is high. (Not a graded recommendation, but part of the treatment algorithm)	All adults (on 2 occasions, 3 mo apart) consider treatment.
TSH: ULN to 10 mIU/L	Treatment should be considered on the basis of individual factors (i.e., symptoms suggestive of hypothyroidism, a positive test for antibodies to thyroid peroxidase, or evidence of atherosclerotic cardiovascular disease, heart failure, or associated risk factors for these diseases). (Grade B, because of a lack of randomized, controlled trials)	Younger patients (< 65 to 70 yr): A trial period of treatment with levothyroxine should be considered when symptoms suggestive of hypothyroidism are present. (Grade 2); Older patients (especially > 80 to 85 yr): Careful follow-up with a wait-and-see strategy, generally avoiding hormonal treatment, is recommended. (Grade 3)	Age < 65 years (on 2 occasions, 3 mo apart): Consider a 6-mo trial of levothyroxine if symptoms are present.

ATA: American Thyroid Association; ETA: European Thyroid Association; NICE: National Institute for Health and Care Excellence; TSH: Thyrotropin.