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In Germany, autoimmune thyroiditis usually manifests as atrophic thyroiditis with functional hypothyroidism affecting elderly women in particular. Sonography and thyroid peroxidase antibodies (TPO antibodies) point the way to the diagnosis. Manifest hypothyroidism always requires substitution with levothyroxine. Many patients with subclinical hypothyroidism, especially those with positive thyroid antibodies, benefit from at least partial thyroxine substitution. Early treatment not only alleviates the clinical symptoms, but may possibly also diminish the associated cardiovascular risk. In pregnant and sterile women subclinical hypothyroidism should always be treated.
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