Skip to main content
SpringerLink
Log in

Overt and Subclinical Hypothyroidism

Who to Treat and How

  • Therapy in Practice
  • Published:
Drugs Aims and scope Submit manuscript

Abstract

Hypothyroidism denotes deficient production of thyroid hormone by the thyroid gland and can be primary (abnormality in thyroid gland itself) or secondary/central (as a result of hypothalamic or pituitary disease). The term ‘subclinical hypothyroidism’ is used to define that grade of primary hypothyroidism in which there is an elevated thyroid-stimulating hormone (TSH) concentration in the presence of normal serum free thyroxine (T4) and triiodothyronine (T3) concentrations. Subclinical hypothyroidism may progress to overt hypothyroidism in approximately 2–5% cases annually. All patients with overt hypothyroidism and subclinical hypothyroidism with TSH >10mIU/L should be treated. There is consensus on the need to treat subclinical hypothyroidism of any magnitude in pregnant women and women who are contemplating pregnancy, to decrease the risk of pregnancy complications and impaired cognitive development of the offspring. However, controversy remains regarding treatment of non-pregnant adult patients with subclinical hypothyroidism and serum TSH values ≤10mIU/L. In this subgroup, treatment should be considered in symptomatic patients, patients with infertility, and patients with goitre or positive anti-thyroid peroxidase (TPO) antibodies. Limited evidence suggests that treatment of subclinical hypothyroidism in patients with serum TSH of up to 10 mIU/L should probably be avoided in those aged >85 years. Other pituitary hormones should be evaluated in patients with central hypothyroidism, especially assessment of the hypothalamic-pituitary-adrenal axis, since hypocortisolism, if present, needs to be rectified prior to initiating thyroid hormone replacement.

Levothyroxine (LT4) monotherapy remains the current standard for management of primary, as well as central, hypothyroidism. Treatment can be started with the full calculated dose for most young patients. However, treatment should be initiated at a low dose in elderly patients, patients with coronary artery disease and patients with long-standing severe hypothyroidism. In primary hypothyroidism, treatment is monitored with serum TSH, with a target of 0.5-2.0 mIU/L. In patients with central hypothyroidism, treatment is tailored according to free or total T4 levels, which should be maintained in the upper half of the normal range for age. In patients with persistently elevated TSH despite an apparently adequate replacement dose of LT4, poor compliance, malabsorption and the presence of drug interactions should be checked. Over-replacement is common in clinical practice and is associated with increased risk of atrial fibrillation and osteoporosis, and hence should be avoided.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Fig. 1.
Fig. 2.
Table III
Table IV
Fig. 3.
Table V

Similar content being viewed by others

References

  1. Wiersinga WM. Hypothyroidism and myxedema coma. In: Jameson JL, DeGroot LJ, editors. Endocrinology adult and pediatric. 6th rev. ed. Philadelphia (PA): Saunders, 2010:1607–22

    Google Scholar 

  2. Brent GA, Larsen PR, Davies TF. Hyopthyroidism and thyroiditis. In: Kronenberg HM, Melmed S, Polonsky KS, et al., editors. Williams textbook of endocrinology. 1 1th rev. ed. Philadelphia (PA): Saunders, 2008: 377–410

    Google Scholar 

  3. Biondi B, Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr Rev 2008 Feb; 29(1): 76–131

    Article  PubMed  CAS  Google Scholar 

  4. Vanderpump MP, Tunbridge WM, French JM, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf) 1995 Jul; 43(1): 55–68

    Article  CAS  Google Scholar 

  5. Roberts CG, Ladenson PW. Hypothyroidism. Lancet 2004 Mar 6; 363(9411): 793–803

    Article  PubMed  CAS  Google Scholar 

  6. Vanderpump MP, Tunbridge WM. Epidemiology and prevention of clinical and subclinical hypothyroidism. Thyroid 2002 Oct; 12(10): 839–47

    Article  PubMed  Google Scholar 

  7. Vanderpump MP. The epidemiology of thyroid diseases. In: Braverman LE, Utiger RD, editors. Werner and Ingabar’s the thyroid: a fundamental and clinical text. Philadelphia (PA): Lippincott Williams & Wilkins, 2005: 398–406

    Google Scholar 

  8. Huber G, Staub JJ, Meier C, et al. Prospective study of the spontaneous course of subclinical hypothyroidism: prognostic value of thyrotropin, thyroid reserve, and thyroid antibodies. J Clin Endocrinol Metab 2002 Jul; 87(7): 3221–6

    Article  PubMed  CAS  Google Scholar 

  9. Díez JJ, Iglesias P. Spontaneous subclinical hypothyroidism in patients older than 55 years: an analysis of natural course and risk factors for the development of overt thyroid failure. J Clin Endocrinol Metab 2004 Oct; 89(10): 4890–7

    Article  PubMed  CAS  Google Scholar 

  10. Braverman LE, Utiger RD. Introduction to hypothyroidism. In: Braverman LE, Utiger RD, editors. Werner and Ingabar’s the thyroid: a fundamental and clinical text. Philadelphia (PA): Lippincott Williams & Wilkins, 2005: 697–9

    Google Scholar 

  11. Singer PA. Primary hypothyroidism due to other causes. In: Braverman LE, Utiger RD, editors. Werner and Ingabar’s the thyroid: a fundamental and clinical text. Philadelphia (PA): Lippincott Williams & Wilkins, 2005: 745–53

    Google Scholar 

  12. Wiersinga WM. Adult hypothyroidism. South Dartmouth (MA): Endocrine Education Inc. [online]. Available from URL: http://www.thyroidmanager.org/chapter9/0-frame.htm [Accessed 2011 Aug 8]

  13. Canaris GJ, Steiner JF, Ridgway EC. Do traditional symptoms of hypothyroidism correlate with biochemical disease? J Gen Intern Med 1997 Sep; 12(9): 544–50

    Article  PubMed  CAS  Google Scholar 

  14. Hueston WJ. Treatment of hypothyroidism. Am Fam Physician 2001 Nov 15; 64(10): 1717–24

    PubMed  CAS  Google Scholar 

  15. Vaidya B, Pearce SH. Management of hypothyroidism in adults. BMJ 2008 Aug 2; 337: 284–9

    Article  Google Scholar 

  16. Surks MI, Ortiz E, Daniels GH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA 2004 Jan 14; 291(2): 228–38

    Article  PubMed  CAS  Google Scholar 

  17. Gharib H, Tuttle RM, Baskin HJ, et al. Subclinical thyroid dysfunction: a joint statement on management from the American Association of Clinical Endocrinologists, the American Thyroid Association, and the Endocrine Society. J Clin Endocrinol Metab 2005 Jan; 90(1): 581–7

    Article  PubMed  CAS  Google Scholar 

  18. Jones DD, May KE, Geraci SA. Subclinical thyroid disease. Am J Med 2010 Jun; 123(6): 502–4

    Article  PubMed  Google Scholar 

  19. Papi G, Uberti ED, Betterle C, et al. Subclinical hypothyroidism. Curr Opin Endocrinol Diabetes Obes 2007 Jun; 14(3): 197–208

    Article  PubMed  Google Scholar 

  20. McDermott MT, Ridgway EC. Subclinical hypothyroidism is mild thyroid failure and should be treated. J Clin Endocrinol Metab 2001 Oct; 86(10): 4585–90

    Article  PubMed  CAS  Google Scholar 

  21. Fatourechi V. Subclinical hypothyroidism: how should it be managed? Treat Endocrinol 2002; 1(4): 211–6

    Article  PubMed  Google Scholar 

  22. Chu JW, Crapo LM. The treatment of subclinical hypothyroidism is seldom necessary. J Clin Endocrinol Metab 2001 Oct; 86(10): 4591–9

    Article  PubMed  CAS  Google Scholar 

  23. Gussekloo J, van Exel E, de Craen AJ, et al. Thyroid status, disability and cognitive function, and survival in old age. JAMA 2004 Dec 1; 292(21): 2591–9

    Article  PubMed  CAS  Google Scholar 

  24. Woeber KA. Treatment of hypothyroidism. In: Braverman LE, Utiger RD, editors. Werner and Ingabar’s the thyroid: a fundamental and clinical text. Philadelphia (PA): Lippincott Williams & Wilkins, 2005: 864–9

    Google Scholar 

  25. Fish LH, Schwartz HL, Cavanaugh J, et al. Replacement dose, metabolism, and bioavailability of levothyroxine in the treatment of hypothyroidism: role of triiodothyronine in pituitary feedback in humans. N Engl J Med 1987 Mar 26; 316(13): 764–70

    Article  PubMed  CAS  Google Scholar 

  26. Mandel SJ, Brent GA, Larsen PR. Levothyroxine therapy in patients with thyroid disease. Ann Intern Med 1993 Sep 15; 119(6): 492–502

    Article  PubMed  CAS  Google Scholar 

  27. US Department of Health and Human Services, US FDA. Sample letter [online]. Available from URL: http://www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/UCM161272.pdf [Accessed 2011 Aug 8]

  28. American Thyroid Association; Endocrine Society; American Association of Clinical Endocrinologists. Joint statement on the U.S. Food and Drug Administration’s decision regarding bioequivalence of levothyroxine sodium. Thyroid 2004 Jul; 14(7): 486

    Article  Google Scholar 

  29. Wiersinga WM. Thyroid hormone replacement therapy. Horm Res 2001; 56 Suppl. 1: 74–81

    Article  PubMed  CAS  Google Scholar 

  30. Celi FS, Zemskova M, Linderman JD, et al. Metabolic effects of liothyronine therapy in hypothyroidism: a randomized, double-blind, crossover trial of liothyronine versus levothyroxine. J Clin Endocrinol Metab. Epub 2011 Aug 24

  31. Clarke N, Kabadi UM. Optimizing treatment of hypothyroidism. Treat Endocrinol 2004; 3(4): 217–21

    Article  PubMed  CAS  Google Scholar 

  32. Armour Thyroid (USP) and combined thyroxine/triiodothyronine as thyroid hormone replacement: a statement from the British Thyroid Association Executive Committee, November 2007 [online]. Available from URL: http://www.british-thyroid-association.org/Guidelines/Docs/Armour_nov_07.pdf [Accessed 2011 Aug 8]

  33. Bunevicius R, Kazanavicius G, Zalinkevicius R, et al. Effects of thyroxine as compared with thyroxine plus triiodothyr-onine in patients with hypothyroidism. N Engl J Med 1999 Feb 11; 340(6): 424–9

    Article  PubMed  CAS  Google Scholar 

  34. Escobar-Morreale HF, Botella-Carretero JI, Escobar del Rey F, et al. Review: treatment of hypothyroidism with combinations of levothyroxine plus liothyronine. J Clin Endocrinol Metab 2005 Aug; 90(8): 4946–54

    Article  PubMed  CAS  Google Scholar 

  35. Grozinsky-Glasberg S, Fraser A, Nahshoni E, et al. Thyroxine-triiodothyronine combination therapy versus thyroxine monotherapy for clinical hypothyroidism: meta-analysis of randomized controlled trials. J Clin Endocrinol Metab 2006 Jul; 91(7): 2592–9

    Article  PubMed  CAS  Google Scholar 

  36. Rees-Jones RW, Larsen PR. Triiodothyronine and thyroxine content of desiccated thyroid tablets. Metabolism 1977 Nov;26(11): 1213–8

    Article  PubMed  CAS  Google Scholar 

  37. Bolk N, Visser TJ, Nijman J, et al. Effects of evening vs morning levothyroxine intake: a randomized double-blind crossover trial. Arch Intern Med 2010 Dec 13; 170(22): 1996–2003

    Article  PubMed  CAS  Google Scholar 

  38. Liwanpo L, Hershman JM. Conditions and drugs interfering with thyroxine absorption. Best Pract Res Clin Endocrinol Metab 2009 Dec; 23(6): 781–92

    Article  PubMed  CAS  Google Scholar 

  39. John-Kalarickal J, Pearlman G, Carlson HE. New medications which decrease levothyroxine absorption. Thyroid 2007 Aug; 17(8): 763–5

    Article  PubMed  CAS  Google Scholar 

  40. Santini F, Pinchera A, Marsili A, et al. Lean body mass is a major determinant of levothyroxine dosage in the treatment of thyroid diseases. J Clin Endocrinol Metab 2005 Jan; 90(1): 124–7

    Article  PubMed  CAS  Google Scholar 

  41. Toft AD. Thyroxine therapy. N Engl J Med 1994 Jul 21; 331(3): 174–80

    Article  PubMed  CAS  Google Scholar 

  42. McDermott MT. In the clinic: hypothyroidism. Ann Intern Med 2009 Dec 1; 151(11): ITC61

    PubMed  Google Scholar 

  43. Grebe SK, Cooke RR, Ford HC, et al. Treatment of hypothyroidism with once weekly thyroxine. J Clin Endocrinol Metab 1997 Mar; 82(3): 870–5

    Article  PubMed  CAS  Google Scholar 

  44. Davis LE, Leveno KJ, Cunningham FG. Hypothyroidism complicating pregnancy. Obstet Gynecol 1988 Jul; 72(1): 108–12

    PubMed  CAS  Google Scholar 

  45. Wasserstrum N, Anania CA. Perinatal consequences of maternal hypothyroidism in early pregnancy and inadequate replacement. Clin Endocrinol (Oxf) 1995 Apr; 42(4): 353–8

    Article  CAS  Google Scholar 

  46. Haddow JE, Palomaki GE, Allan WC, et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med 1999 Aug 19; 341(8): 549–55

    Article  PubMed  CAS  Google Scholar 

  47. Abalovich M, Amino N, Barbour LA, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2007 Aug; 92 (8 Suppl.): S1–47

    Article  PubMed  CAS  Google Scholar 

  48. Alexander EK, Marqusee E, Lawrence J, et al. Timing and magnitude of increases in levothyroxine requirements during pregnancy in women with hypothyroidism. N Engl J Med 2004 Jul 15; 351(3): 241–9

    Article  PubMed  CAS  Google Scholar 

  49. Fitzpatrick DL, Russell MA. Diagnosis and management of thyroid disease in pregnancy. Obstet Gynecol Clin North Am 2010 Jun; 37(2): 173–93

    Article  PubMed  Google Scholar 

  50. Aronow WS. The heart and thyroid disease. Clin Geriatr Med 1995 May; 11(2): 219–29

    PubMed  CAS  Google Scholar 

  51. Keating FR, Parkin TW, Selby JB, et al. Treatment of heart disease associated with myxedema. Prog Cardiovasc Dis 1961 Jan; 3: 364–81

    PubMed  Google Scholar 

  52. Sawin CT. Thyroid dysfunction in older persons. Adv Intern Med 1992; 37: 223–48

    PubMed  CAS  Google Scholar 

  53. Laurberg P, Andersen S, Bülow Pedersen I, et al. Hypothyroidism in the elderly: pathophysiology, diagnosis and treatment. Drugs Aging 2005; 22(1): 23–38

    Article  PubMed  CAS  Google Scholar 

  54. Gussekloo J, van Exel E, de Craen AJ, et al. Thyroid function, activities of daily living and survival in extreme old age: the ‘Leiden 85-plus Study’. Ned Tijdschr Geneeskd 2006 Jan 14; 150(2): 90–6

    PubMed  CAS  Google Scholar 

  55. Rastogi MV, LaFranchi SH. Congenital hypothyroidism. Orphanet J Rare Dis 2010 Jun 10; 5: 17

    Article  PubMed  Google Scholar 

  56. American Academy of Pediatrics, Rose SR; Section on Endocrinology and Committee on Genetics, American Thyroid Association, Brown RS; Public Health Committee, Lawson Wilkins Pediatric Endocrine Society, et al. Update of newborn screening and therapy for congenital hypothyroidism. Pediatrics 2006 Jun; 117(6): 2290–303

    Article  Google Scholar 

  57. Vliet GV. Hypothyroidism in infants and children: congenital hypothyroidism. In: Braverman LE, Utiger RD, editors. Werner and Ingabar’s the thyroid: a fundamental and clinical text. Philadelphia (PA): Lippincott Williams & Wilkins, 2005: 1033–41

    Google Scholar 

  58. Working Group on Neonatal Screening of the European Society for Paediatric Endocrinology. Revised guidelines for neonatal screening programmes for primary congenital hypothyroidism. Horm Res 1999; 52(1): 49–52

    Article  Google Scholar 

  59. Vliet GV. Hypothyroidism in infants, children, and adolescents: acquired hypothyroidism. In: Braverman LE, Utiger RD, editors. Werner and Ingabar’s the thyroid: a fundamental and clinical text. Philadelphia (PA): Lippincott Williams & Wilkins, 2005: 1041–7

    Google Scholar 

  60. Counts D, Varma SK. Hypothyroidism in children. Pediatr Rev 2009 Jul; 30(7): 251–8

    Article  PubMed  Google Scholar 

  61. Setian N. Hypothyroidism in children: diagnosis and treatment. J Pediatr (Rio J) 2007 Nov; 83 (5 Suppl.): S209–16

    Article  Google Scholar 

  62. Moore DC. Natural course of ‘subclinical’ hypothyroidism in childhood and adolescence. Arch Pediatr Adolesc Med 1996 Mar; 150(3): 293–7

    Article  PubMed  CAS  Google Scholar 

  63. Wasniewska M, Salerno M, Cassio A, et al. Prospective evaluation of the natural course of idiopathic subclinical hypothyroidism in childhood and adolescence. Eur J Endocrinol 2009 Mar; 160(3): 417–21

    Article  PubMed  CAS  Google Scholar 

  64. Cerbone M, Bravaccio C, Capalbo D, et al. Linear growth and intellectual outcome in children with long-term idiopathic subclinical hypothyroidism. Eur J Endocrinol 2011 Apr; 164(4): 591–7

    Article  PubMed  CAS  Google Scholar 

  65. Kaplowitz PB. Subclinical hypothyroidism in children: normal variation or sign of a failing thyroid gland? Int J Pediatr Endocrinol 2010; 281453 [online]. Available from URL: http://www.ijpeonline.com/content/2010/1/281453 [Accessed 2011 Aug 8]

  66. Mohn A, Di Michele S, Di Luzio R, et al. The effect of subclinical hypothyroidism on metabolic control in children and adolescents with type 1 diabetes mellitus. Diabet Med 2002 Jan; 19(1): 70–3

    Article  PubMed  CAS  Google Scholar 

  67. McGriff NJ, Csako G, Gourgiotis L, et al. Effects of thyroid hormone suppression therapy on adverse clinical outcomes in thyroid cancer. Ann Med 2002; 34(7–8): 554–64

    Article  PubMed  CAS  Google Scholar 

  68. Cooper DS, Doherty GM, Haugen BR, et al., on behalf of American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009 Nov; 19(11): 1167–214

    Article  PubMed  Google Scholar 

  69. Pacini F, Schlumberger M, Dralle H, et al., on behalf of European Thyroid Cancer Taskforce. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 2006 Jun; 154(6): 787–803

    Article  PubMed  CAS  Google Scholar 

  70. Martino E, Pinchera A. Central hypothyroidism. In: Braverman LE, Utiger RD, editors. Werner and Ingabar’s the thyroid: a fundamental and clinical text. Philadelphia (PA): Lippincott Williams & Wilkins, 2005: 754–68

    Google Scholar 

  71. Yamada M, Mori M. Mechanisms related to the pathophysiology and management of central hypothyroidism. Nat Clin Pract Endocrinol Metab 2008 Dec; 4(12): 683–94

    Article  PubMed  CAS  Google Scholar 

  72. Lania A, Persani L, Beck-Peccoz P. Central hypothyroidism. Pituitary 2008; 11(2): 181–6

    Article  PubMed  CAS  Google Scholar 

  73. Porretti S, Giavoli C, Ronchi C, et al. Recombinant human GH replacement therapy and thyroid function in a large group of adult GH-deficient patients: when does L-T(4) therapy become mandatory? J Clin Endocrinol Metab 2002 May; 87(5): 2042–5

    Article  PubMed  CAS  Google Scholar 

  74. Arafah BM. Increased need for thyroxine in women with hypothyroidism during estrogen therapy. N Engl J Med 2001 Jun 7; 344(23): 1743–9

    Article  PubMed  CAS  Google Scholar 

  75. Nicoloff JT. Thyroid storm and myxedema coma. Med Clin North Am 1985 Sep; 69(5): 1005–17

    PubMed  CAS  Google Scholar 

  76. Fliers E, Wiersinga WM. Myxedema coma. Rev Endocr Metab Disord 2003 May; 4(2): 137–41

    Article  PubMed  Google Scholar 

  77. Kwaku MP, Burman KD. Myxedema coma. J Intensive Care Med 2007 Jul-Aug; 22(4): 224–31

    Article  PubMed  Google Scholar 

  78. Ringel MD. Management of hypothyroidism and hyper-thyroidism in the intensive care unit. Crit Care Clin 2001 Jan; 17(1): 59–74

    Article  PubMed  CAS  Google Scholar 

  79. Wartofsky L. Myxedema coma. Endocrinol Metab Clin North Am 2006 Dec; 35(4): 687–98

    Article  PubMed  CAS  Google Scholar 

  80. Arlot S, Debussche X, Lalau JD, et al. Myxoedema coma: response of thyroid hormones with oral and intravenous high-dose L-thyroxine treatment. Intensive Care Med 1991; 17(1): 16–8

    Article  PubMed  CAS  Google Scholar 

  81. Dutta P, Bhansali A, Masoodi SR, et al. Predictors of outcome in myxoedema coma: a study from a tertiary care centre. Crit Care 2008; 12(1): R1

    Article  PubMed  Google Scholar 

  82. Yamamoto T, Fukuyama J, Fujiyoshi A. Factors associated with mortality of myxedema coma: report of eight cases and literature survey. Thyroid 1999 Dec; 9(12): 1167–74

    Article  PubMed  CAS  Google Scholar 

  83. Parle JV, Franklyn JA, Cross KW, et al. Thyroxine prescription in the community: serum thyroid stimulating hormone level assays as an indicator of undertreatment or overtreatment. Br J Gen Pract 1993 Mar; 43(368): 107–9

    PubMed  CAS  Google Scholar 

  84. Ross DS, Daniels GH, Gouveia D. The use and limitations of a chemiluminescent thyrotropin assay as a single thyroid function test in an out-patient endocrine clinic. J Clin Endocrinol Metab 1990 Sep; 71(3): 764–9

    Article  PubMed  CAS  Google Scholar 

  85. Canaris GJ, Manowitz NR, Mayor G, et al. The Colorado thyroid disease prevalence study. Arch Intern Med 2000 Feb 28; 160(4): 526–34

    Article  PubMed  CAS  Google Scholar 

  86. Uzzan B, Campos J, Cucherat M, et al. Effects on bone mass of long term treatment with thyroid hormones: a meta-analysis. J Clin Endocrinol Metab 1996 Dec; 81(12): 4278–89

    Article  PubMed  CAS  Google Scholar 

  87. Faber J, Galløe AM. Changes in bone mass during prolonged subclinical hyperthyroidism due to L-thyroxine treatment: a meta-analysis. Eur J Endocrinol 1994 Apr; 130(4): 350–6

    Article  PubMed  CAS  Google Scholar 

  88. Sawin CT, Geller A, Wolf PA, et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med 1994 Nov 10; 331(19): 1249–52

    Article  PubMed  CAS  Google Scholar 

  89. Shakir KM, Turton D, Aprill BS, et al. Anemia: a cause of intolerance to thyroxine sodium. Mayo Clin Proc 2000 Feb; 75(2): 189–92

    PubMed  CAS  Google Scholar 

  90. Shibata H, Hayakawa H, Hirukawa M, et al. Hypersensitivity caused by synthetic thyroid hormones in a hypothyroid patient with Hashimoto’s thyroiditis. Arch Intern Med 1986 Aug; 146(8): 1624–5

    Article  PubMed  CAS  Google Scholar 

  91. Rovet JF, Daneman D, Bailey JD. Psychologic and psycho-educational consequences of thyroxine therapy for juvenile acquired hypothyroidism. J Pediatr 1993 Apr; 122(4): 543–9

    Article  PubMed  CAS  Google Scholar 

  92. Van Dop C, Conte FA, Koch TK, et al. Pseudotumor cerebri associated with initiation of levothyroxine therapy for juvenile hypothyroidism. N Engl J Med 1983 May 5; 308(18): 1076–80

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

No sources of funding were used to conduct this study or prepare this manuscript.The authors have no conflicts of interest that are directly relevant to the content of this article.

Author information

Authors and Affiliations

  1. Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, 110029, India

    Deepak Khandelwal &  Nikhil Tandon

Authors
  1. Deepak Khandelwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nikhil Tandon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nikhil Tandon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Khandelwal, D., Tandon, N. Overt and Subclinical Hypothyroidism. Drugs 72, 17–33 (2012). https://doi.org/10.2165/11598070-000000000-00000

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/11598070-000000000-00000

Keywords

Search

Navigation