Should patients with mild subclinical hypothyroidism (TSH < 10 mIU/L) be treated with thyroid hormone replacement to improve their lipid profile?

There is a well-known association between untreated primary hypothyroidism and hypercholesterolemia with subsequent improvement of lipid profile following thyroxine replacement. However, the link between hyperlipidemia and sub-clinical hypothyroidism is less well understood. The all-important question, whether treating subclinical hypothyroidism improves lipid profile resulting in favorable cardiac outcomes remains unsettled. Studies have been conflicting at best. Trials have not shown normaliza...

Yes, I think it is very reasonable to consider thyroid replacement in patients with hyperlipidemia and subclinical hypothyroidism. While studies have shown that profound hypothyroidism decreases LDL receptor expression, it is quite likely that even mild hypothyroidism has some effect. T3 analogues (liver-specific) have been shown to reduce lipids. As long as overreplacement is avoided, levothyroxine therapy in patients with mild TSH elevation may help lower lipids.