Management of hypothyroidism in adults

  title={Management of hypothyroidism in adults},
  author={Bijay Vaidya and Simon H S Pearce},
  journal={BMJ : British Medical Journal},
Hypothyroidism is one of the commonest chronic disorders in Western populations. In the United Kingdom, the annual incidence of primary hypothyroidism in women is 3.5 per 1000 and in men 0.6 per 1000.1 During 2006 12 million prescriptions for levothyroxine (50 μg or 100 μg tablets) were dispensed in England, equivalent to about 1.6 million people taking long term thyroid replacement therapy, about 3% of the population.2 The management of hypothyroidism is generally considered straightforward… 

Management of Subclinical Hypothyroidism: The Thyroidologists’ View

A snapshot of the range of accepted clinical practice in this common condition is formed, for a 53-year-old woman with fatigue and difficulty losing weight, who has a serum TSH of 6.8 mU/l and strongly positive thyroid peroxidase antibodies, 95% of respondents would treat with levothyroxine.

Hypothyroidism: Investigation and management

The aetiology, clinical features, investigation and management of hypothyroidism is outlined, with the significance of elevated TSH associated with thyroid hormones within normal range is controversial; thyroxine replacement may be beneficial in some cases.

Overt Hypothyroidism in Hospitalized Patients: Clinical Characteristics

Clinical manifestations of in-patients with overt hypothyroidism include multiple non-specific symptoms, mainly weakness and constipation, while typical “hypothyroid” symptoms such as cold intolerance and weight gain are often overlooked.

Trends in thyroid hormone prescribing and consumption in the UK

Analysis of the full costs of 28-day dispensing balanced against the potential savings of reduced wastage of thyroid medications, suggests that this is unlikely to be an economically effective public health policy.

The Thyroid Registry: Clinical and Hormonal Characteristics of Adult Indian Patients with Hypothyroidism

Most of the patients as observed in this registry received treatment with levothyroxine based on TSH levels alone, thus highlighting the need for awareness and scientific education among clinicians in India.

TSH levels and risk of miscarriage in women on long-term levothyroxine: a community-based study.

The majority of levothyroxine-treated women have early gestational TSH levels above the recommended targets with a strong risk of miscarriage at levels exceeding 4.5 mU/L, and there is an urgent need to improve the adequacy of thyroid hormone replacement in early pregnancy.


It is suggested that yoga can be an effective adjunct therapy in thyroid conditions and further studies in larger samples are needed to confirm these findings and to better understand the mechanisms behind such beneficial effects in patients of thyroid disorders.

Drug Interactions with Levothyroxine Therapy in Patients with Hypothyroidism: Observational Study in General Practice

Clinicians should carefully consider adjusting levothyroxine therapy in presence of concomitant drugs, such as proton-pump inhibitors, which may reduce lev Timothyroxine bioavailability.

Hypothyroidism after a cancer diagnosis: etiology, diagnosis, complications, and management.

Thyroid dysfunction can be easily overlooked in cancer patients because of the complexity of cancer's clinical picture, particularly in the pediatric population and the management of both hypothyroidism and the malignancy.

Respiratory Manifestations of Hypothyroidism: A Systematic Review.

Mechanistic data linking hypothyroidism and respiratory function are at best limited and this area of research is open for retesting hypotheses, using appropriate study designs and methods.



Thyroid hormone replacement for subclinical hypothyroidism.

In current RCTs, levothyroxine replacement therapy for subclinical hypothyroidism did not result in improved survival or decreased cardiovascular morbidity, and some evidence indicates that levothyoxine replacement improves some parameters of lipid profiles and left ventricular function.

Unresolved questions in managing hypothyroidism during pregnancy

In this article, autoimmune thyroiditis is defined as the presence of measurable circulating antithyroid autoantibodies (to thyroglobulin or thyroperoxidase), irrespective of abnormalities of thyroid function.

Subclinical thyroid disease: scientific review and guidelines for diagnosis and management.

The strength of the evidence that untreated subclinical thyroid disease is associated with clinical symptoms and adverse clinical outcomes was assessed and recommendations for clinical practice developed and insufficient evidence to support population-based screening was found.

The starting dose of levothyroxine in primary hypothyroidism treatment: a prospective, randomized, double-blind trial.

A full starting dose of levothyroxine in cardiac asymptomatic patients with primary hypothyroidism is safe and may be more convenient and cost-effective than a low starting dose regimen.

Celiac disease presenting as resistant hypothyroidism.

The case of a 58-year-old woman with autoimmune hypothyroidism who was initially suspected of having celiac disease on the basis of apparent resistance to levothyroxine therapy is reported, and who had no other clinical or laboratory clues to suggest the diagnosis.

Thyroxine prescription in the community: serum thyroid stimulating hormone level assays as an indicator of undertreatment or overtreatment.

Thyroxine prescription was common in the four general practices sampled, although indications for its use were appropriate, and abnormal serum levels found in those prescribed thyroxine for hypothyroidism were found to be high.

Thyroxine-triiodothyronine combination therapy versus thyroxine monotherapy for clinical hypothyroidism: meta-analysis of randomized controlled trials.

T(4) monotherapy should remain the treatment of choice for clinical hypothyroidism, and no difference was found in the effectiveness of combination vs. monotherapy in the following symptoms.

Small changes in thyroxine dosage do not produce measurable changes in hypothyroid symptoms, well-being, or quality of life: results of a double-blind, randomized clinical trial.

Small changes in T(4) dosage do not produce measurable changes in hypothyroid symptoms, well-being, or quality of life, despite the expected changes in serum TSH and markers of thyroid hormone action.

The influence of age on the relationship between subclinical hypothyroidism and ischemic heart disease: a metaanalysis.

SCH is associated with increased IHD (both prevalence and incidence) and cardiovascular mortality only in subjects from younger populations, suggesting that increased vascular risk may only be present in younger individuals with SCH.

L-thyroxine requirement in patients with autoimmune hypothyroidism and parietal cell antibodies.

Autoimmune gastritis is an additional factor affecting l-T(4) requirement in patients with autoimmune thyroiditis, and serum parietal cell antibodies (PCA) measurement should be considered in Patients with an unexplained high requirement of l- T(4).