If symptoms or signs such as hypercholesterolemia are the sole indication for therapy, and they don't improve, consider stopping therapy. A suspicion of central hypothyroidism, in which the thyroid problem is secondary to a pituitary or hypothalamic disorder. The ACP recommends a trial of thyroxine therapy for patients with symptoms, as well as establishing a follow-up plan for patients with mild or no symptoms. Follow-up every two to five years should include a history, physical examination, and repeat thyroid function tests. Patients older than 60 with suppressed serum TSH concentrations triple their risk of atrial fibrillation.
Mild thyrotoxicosis can also cause loss of bone mineral, particularly in postmenopausal women.
Hyperthyroidism is known to be a risk factor for osteoporosis because it shifts the balance of bone resorption and new bone formation toward greater bone resorption. How to manage asymptomatic patients found to have mild thyrotoxicosis on routine screening is controversial. Patients with risk factors for cardiac disease or osteoporosis are more likely to develop complications related to mild hyperthyroidism. Once a decision is made to treat mild thyrotoxicosis, radioiodine is usually preferred as a definitive, permanently effective approach. Although antithyroid drugs may be useful as a trial to determine whether nonspecific symptoms are due to hypothyroidism, they do not represent an attractive long-term solution, particularly in the elderly.