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An elevated thyroid-stimulating hormone (TSH) in patients with a normal free thyroxine level reflects the state of subclinical hypothyroidism. Asymptomatic patients with a TSH of 10 U/L, treatment can be considered, particularly if it is persistent and associated with positive antibodies, as beneficial effects on lipid profile, cardiac contractility, etc. have been seen in some studies. Given the lack of strong evidence for or against treatment, both observation without treatment, or early treat- ment are reasonable options.