American Board of Internal Medicine (ABIM) Certification Practice Exam

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At what TSH level should you consider treating subclinical hypothyroidism?

The correct answer is: 10

The appropriate threshold for considering treatment in cases of subclinical hypothyroidism typically revolves around the TSH (thyroid-stimulating hormone) level of around 10 mIU/L. Subclinical hypothyroidism is characterized by an elevated TSH level while free thyroxine (T4) remains within the normal range. When the TSH level exceeds 10 mIU/L, there is a growing body of evidence suggesting that the risks of cardiometabolic complications, symptoms of hypothyroidism, and the potential for progression to overt hypothyroidism increase. This threshold is especially significant in individuals who exhibit symptoms, are at high risk for cardiovascular disease, or have elevated cholesterol levels. Consequently, initiating treatment with levothyroxine can help manage these risks and alleviate potential symptoms. Monitoring and clinical judgment also play vital roles in decision-making, but the 10 mIU/L mark serves as a crucial point for intervention in the management of subclinical hypothyroidism.