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Hypotyreos, subklinisk

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Definition:
Subklinisk hypotyreos definieras som TSH över referensområdet (vanligen <10 mE/L), samtidigt som värdet på FT4 är inom referensområdet.
Förekomst:
Vid screening av vuxna har man funnit en förekomst på 3,6 % bland män och 4,8 % bland kvinnor, ökande med ålder.
Symtom:
Inga typiska symtom på hypotyreos, men många patienter har generella symtom på låg ämnesomsättning.
Kliniska fynd:
Inga säkra typiska symtom eller tecken på hypotyreos.
Diagnostik:
TSH över referensområdet, samtidigt som värdet på FT4 är inom referensområdet. Förhöjt anti-TPO  ökar sannolikheten för utveckling till overt hypotyreos då FT4 samtidigt blivit lågt.
Behandling:
Behandling med tyroxin rekommenderas till personer med subklinisk hypotyreos vid TSH >7 mE/L i flera mätningar och vid diffus atoxisk struma. Positiv anti-TPO stärker indikationen för behandling. Behandling kan också övervägas vid stadigvarande TSH 4–7 om det föreligger symptom som skulle kunna vara förenliga med hypotyreos – särskilt vid positiva anti-TPO – men fås ingen effekt på symptomen bör utsättning övervägas.
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  • Helena Filipsson Nyström, med dr och specialist i internmedicin, Institutionen för Medicin, Sahlgrenska akademin, Göteborgs universitet
  • Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet