Kanji Kuma, MD ■ Shuji Fukata, MD ■ Masahiro Sugawara, MD

Hypothyroidism is the state of decreased thyroid hormone action at the target tissue. There are two types of hypothyroidism, on the basis of thyroid function tests: (1) clinical or overt and (2) subclinical. Patients with the former show elevated serum thyroid-stimulating hormone (TSH) and reduced serum thyroid hormone levels, which are the characteristic laboratory findings of primary hypothyroidism. The latter disorder is characterized by a mildly elevated serum TSH concentration and normal serum thyroid hormone levels. Subclinical hypothyroidism is the most common thyroid dysfunction nationwide, with a marked increase in prevalence in the elderly population.12 Hypothyroidism, including subclinical hypothyroidism, can cause cardiovascular problems, lipid disorders, cognitive dysfunction, neurologic abnormalities, and a high rate of abortion. An extreme case of untreated hypothyroidism is myxedema coma. The timely detection of hypothyroidism and appropriate therapy with thyroid hormone are beneficial for patients and reduce perioperative morbidity as well as mortality.

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