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Non-thyroidal Hypothyroidism

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Management of Patients with Pseudo-Endocrine Disorders

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Abstract

Hypothyroidism is characterized by deficient tissue thyroid hormone action overwhelmingly due to deficient endogenous thyroid hormone synthesis and secretion by the thyroid. Overt and subclinical hypothyroidism may or may not be associated with nonspecific symptoms that have become identified as consistent with the presence of hypothyroidism but are by no means specific to deficient thyroid hormone action. The diagnosis of hypothyroidism has evolved from a clinical impression based on symptoms (which some practitioners continue to deem sufficient) and now should also include biochemical evidence of thyroid dysfunction as indicated by contemporary guidelines for clinical practice. Once accurately diagnosed, hypothyroidism is expected to be readily treated by replacing thyroid hormone. The clinical management of hypothyroidism is assumed to be simple and direct. It is also assumed by some that symptoms persisting in patients diagnosed as hypothyroid are due to ongoing deficiency in thyroid hormone action on the impacted tissues of the body. But why would we assume that the initiation of thyroid hormone in subjects with symptoms “consistent with hypothyroidism” who are not hypothyroid should result in resolution of these non-thyroid complaints? This discussion examines potential pitfalls in diagnosis and how patients are selected for treatment with thyroid replacement and questions the safety and outcomes of thyroid hormone replacement therapy. Additionally, this review explores alternative explanations for symptoms that may result in the initial assessment of thyroid function tests and the diagnosis of hypothyroidism and offers an approach to persistent symptoms in those on thyroid hormone replacement presumed to be hypothyroid.

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Authors and Affiliations

  1. Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA

    James V. Hennessey

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Correspondence to James V. Hennessey .

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  1. University of Colorado Hospital, Aurora, CO, USA

    Michael T. McDermott

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Hennessey, J.V. (2019). Non-thyroidal Hypothyroidism. In: McDermott, M. (eds) Management of Patients with Pseudo-Endocrine Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-22720-3_20

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  • DOI: https://doi.org/10.1007/978-3-030-22720-3_20

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