Hypothyroidism, a progressive disorder of the thyroid gland, is a common condition affecting more women than men. The prevalence of age-related hypothyroidism in women is well documented. Associated hyperlipidemia is common especially in the clinical presence of positive serum antithyroid antibodies. The relationship between subclinical hypothyroidism (SH) and hyperlipidemia among women is less well known. Although as many as 24% of elderly women with SH will progress to overt hypothyroidism, routine screening for thyroid dysfunction is not widely accepted among health care professionals and organizations. This article will review the literature on SH in women in relation to serum lipid concentrations and associated pathology. Clinical guidelines and an algorithm for screening and managing SH in view of hyperlipidemia will be suggested.