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Diagnosis and Treatment of Hypothyroidism

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Thyroid Diseases

Part of the book series: Endocrinology ((ENDOCR))

Abstract

Hypothyroidism is a common medical condition which affects predominantly women and the elderly. Symptoms of hypothyroidism are nonspecific and frequently encountered in the general population; therefore the diagnosis is suspected in many but confirmed in only a few. Hence thyroid function tests are some of the most requested laboratory tests. The diagnosis of hypothyroidism is confirmed when serum thyrotropin (TSH) levels are above the reference range in the presence of low circulating thyroid hormones. However, the reference range for both serum TSH and thyroid hormones in the population is wide, and there is continuous debate as to what constitutes the “normal” range for a given individual.

Treatment of hypothyroidism with thyroid hormone replacement therapy is thought to be relatively straightforward and usually lifelong. Treatment of choice is levothyroxine (LT4), a synthetic thyroid hormone that is chemically identical to thyroxine (T4). The body is able to generate the active thyroid hormone triiodothyronine (T3) from LT4 peripherally by the action of deiodinasing enzymes. Therapy with appropriate doses of LT4 restores biochemical euthyroidism by increasing serum T4 and reducing serum TSH levels to within the reference range. However, some patients with hypothyroidism who are treated with LT4 therapy and whose serum TSH level is within the reference range complain of residual hypothyroid symptoms. In addition, circulating levels of T3 tend to be lower with LT4 monotherapy compared to euthyroid controls, even when serum TSH levels are similar. It is therefore argued that other forms of thyroid hormone replacement (such as T4 and T3 combinations or with desiccated thyroid extract) may be a more physiological form of replacement. The majority of interventional trials of these alternative therapies have so far been unable to show any benefit. It is possible that these alternative therapies may be useful in certain subgroups of patients but this is yet to be proven.

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Authors and Affiliations

  1. Institute of Genetic Medicine, Central Parkway, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK

    Suhel Ashraff & Salman Razvi

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  1. Suhel Ashraff
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  2. Salman Razvi
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  1. Department of Endocrinology, University of Pisa, Pisa, Italy

    Paolo Vitti

  2. Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark

    Laszlo Hegedüs

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Ashraff, S., Razvi, S. (2018). Diagnosis and Treatment of Hypothyroidism. In: Vitti, P., Hegedüs, L. (eds) Thyroid Diseases. Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-319-45013-1_14

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