Subclinical hypothyroidism (SH) is characterized by normal serum free T4 and free T3 levels and increased serum TSH levels. The relationship between SH and cardiovascular diseases has been one of the most popular topics recently. There is still some controversy concerning the cardiovascular impact of SH and management protocols. The vast majority of the studies published so far, suggests that SH accelerates endothelial dysfunction through traditional effects on risk factors that promote atherosclerosis and nontraditional effects on vasculature. In particular, SH is associated with increased of LDL-cholesterol, diastolic blood pressure, and markers of chronic inflammation (C reactive protein) and simultaneously reduces the bioavailability of nitric oxide to blood vessels and increases the expression of angiotensin receptor. Furthermore, replacement therapy seems to improve all these aspects.