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Lookup NU author(s): Dr Salman Razvi


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Hypothyroidism is the common clinical condition of thyroid hormone deficiency and if left untreated can lead to serious adverse health effects on multiple organ systems, with the cardiovascular system as the most robustly studied target. Overt primary hypothyroidism is defined as elevated thyroid-stimulating hormone (TSH) concentration in combination with free thyroxine (fT4) concentration below the reference range. Subclinical hypothyroidism, commonly considered an early sign of thyroid failure, is defined by elevated TSH concentrations but fT4 concentrations within the reference range. Hypothyroidism is classified as primary, central or peripheral based on pathology in the thyroid, the pituitary or hypothalamus, or peripheral tissue, respectively. Acquired primary hypothyroidism is the most prevalent form and can be caused by severe iodine deficiency but is more frequently caused by chronic autoimmune thyroiditis in iodine-replete areas. The onset of hypothyroidism is insidious in most cases and symptoms may present relatively late in the disease process. There is large variation in clinical presentation and the presence of hypothyroid symptoms, especially in pregnancy and in children. Levothyroxine (LT4) is the mainstay of treatment and is one of the most commonly prescribed drugs worldwide. After normalization of TSH and fT4concentrations, a considerable proportion of patients treated with LT4 continue to have persistent symptoms, compromising quality of life. Further research is needed regarding the appropriateness of currently applied reference ranges and treatment thresholds, particularly in pregnancy, and the potential benefit of LT4/liothyronine (LT3) combination therapy for thyroid-related symptom relief, patient satisfaction and long-term effects.

Publication metadata

Author(s): Chaker L, Razvi S, Bensenor IM, Azizi F, Pearce EN, Peeters RP

Publication type: Review

Publication status: Published

Journal: Nature Reviews Disease Primers

Year: 2022

Volume: 8

Issue: 30

Online publication date: 19/05/2022

Acceptance date: 06/04/2022

ISSN (electronic): 2056-676X


DOI: 10.1038/s41572-022-00357-7