A review regarding the article 'systematic review and meta-analysis of levothyroxine effect on blood pressure in patients with subclinical hypothyroidism'.

Subclinical hypothyroidism (SCH) is a biochemical condition defined by elevated serum thyroid stimulating hormone levels in the setting of normal levels of the peripheral thyroid hormones, thyroxine, and triiodothyronine. SCH is becoming increasingly prevalent in recent years especially among the elderly, and its prevalence ranges approximately from 5 to 20% in the general population. Clinical manifestations of SCH range from obvious symptoms to no signs or symptoms, and the most common symptoms of SCH include fatigue, mild depression, muscle weakness, cold intolerance, and weight gain. However, despite the clear biochemical pattern of mild thyroid failure, few patients with SCH have typical hypothyroid symptoms. Patients with SCH have elevated blood pressure, but the effect of levothyroxine (LT4) therapy on blood pressure among those patients is still unclear. Severe SCH or mild SCH with symptoms are generally recommended to be treated with levothyroxine (LT4), which requires monitoring of TSH level over several months and adjusting LT4 dosage accordingly. Oral LT4 administered daily is the treatment of choice for SCH, and the goal of LT4 treatment for SCH is to restore the TSH level within the reference range.