Treatment Of Primary Hypothyroidism Research Articles

Comparative analysis of scaffold fibre diameter-modulated responses on immortalized and primary thyroid cells: Implications for thyroid regeneration

Primary hypothyroidism results from thyroid gland damage, commonly due to radiotherapy for head and neck cancer. Primary hypothyroidism severely impacts patient quality of life and is expected to increase in incidence due to the aging population and rising cancer survivor rates. Tissue engineering approaches are starting to emerge as a potential treatment.Electrospinning techniques have yet to be investigated in conjunction with thyroid tissue. Here, electrospun polycaprolactone scaffolds with varying fibre diameters were fabricated and their effects on immortalized human thyrocytes (Nthy-ori 3–1) and primary murine thyroid cells were investigated. Four groups of scaffolds were produced with fibre diameters ranging from approximately 0.5 µm to 4 µm, to understand the impact of these microenvironments on their potential for thyroid regeneration.Results showed that fibre size influenced mechanical properties, porosity and cell response. Nthy-ori 3–1 cells performed best on the scaffold with medium-sized fibres while primary cells preferred the scaffold with larger fibres. Nonetheless, the scaffold with the smallest fibre diameter encouraged the secretion of collage-like fibrils, potentially indicating favourable conditions for regeneration.This study highlights the potential of electrospun PCL scaffolds as promising candidates for tissue engineering applications in the treatment of primary hypothyroidism. The findings demonstrate the importance of tailoring scaffold properties and considering cell-type specific responses when designing biomaterials for tissue-engineered solutions for thyroid regeneration. Further research is necessary to elucidate the underlying mechanisms and optimize scaffold properties for successful thyroid tissue regeneration.

Posttreatment symptoms in hypothyroidism and correlations with thyroid-stimulating hormone and free triiodothyronine and free thyroxine: A ThyPRO-based follow-up study

ABSTRACT Background: Treatment of primary hypothyroidism with levothyroxine does not fully alleviate its symptoms. Though there have studies to correlate levels of tri-iodothyronine with symptomatology, its role still remains controversial. Aims: To study symptoms of hypothyroidism before and after levo-thyroxine therapy using ThyPRO 39 scores and to correlate these with thyroid hormone levels. Materials and Methods: This quasi-experimental study was conducted at the in and outpatients' departments of Internal Medicine and Endocrinology of St John's Medical College Hospital. Patients were enrolled if they were aged over 18 years and were diagnosed with hypothyroidism (TSH>/= 10 IU/l). Pregnant ladies and patients who had undergone radioiodine therapy or were diagnosed with thyroid cancers were excluded. Results: A total of 46 (F=28) patients were enrolled into the study. The mean age of the study group was 41.63 +/-SD 12.078 years.Among hypothyroid symptoms at diagnosis, Tiredness and Emotional Susceptibility had the highest effect size. Tiredness, Cognitive complaints and Depressive symptoms had significant negative correlation with fT3.While Goitre, Tiredness, and Cognitive complaints showed significant association with TSH, no correlations were noted with fT4 and many scores. There was a statistically significant negative correlation between fT3 and post therapy domain scores of Goitre, Tiredness, Impaired Daily Life and Impaired Social Life. There was a significant difference in the QoL domain between those with and without co-morbidities, the latter group having lower scores signifying better QoL. Conclusion: Symptoms of hypothyroidism may have a correlation with fT3 levels. Larger well-designed studies with supplementation of T3(triiodothyronine) and correlation with symptoms and tissue levels of fT3 will give conclusive answers.

Unusual causes of hyperthyrotropinemia and differential diagnosis of primary hypothyroidism: a revised diagnostic flowchart.

The clinical consequences of primary hypothyroidism include cardiovascular morbidity, increased mortality, and poor quality of life; therefore guidelines endorsed by several Scientific Societies recommend measuring circulating thyroid-stimulating hormone (TSH) in patients at risk. The assessment of serum TSH levels is also deemed to be the most robust and accurate biomarker during the management of replacement therapy in patients with a previous diagnosis of primary hypothyroidism. In line with a reflex TSH laboratory strategy, free thyroxine is measured only if the TSH falls outside specific cutoffs, in order to streamline investigations and save unjustified costs. This serum TSH-based approach to both diagnosis and monitoring has been widely accepted by several national and local health services; nevertheless, false-negative or -positive testing may occur, leading to inappropriate management or treatment. This review aims to describe several infrequent causes of increased circulating TSH, including analytical interferences, resistance to TSH, consumptive hypothyroidism, and refractoriness to levothyroxine replacement treatment. We propose a clinical flowchart to aid correct recognition of these various conditions, which represent important potential pitfalls in the diagnosis and treatment of primary hypothyroidism.

Diagnosis and Treatment of Primary Hypothyroidism in Primary Care

Decreased thyroid function occurs among 0,2–1% of men and 1,4–5% of women in the general population, and among people over 60 years among 2,5% of men and 6% of women. Hypothyroidism in 95% of cases is caused by thyroid disfunction (primary hypothyroidism), only 5% of cases are central hypothyroidism, associated with dysfunction of the pituitary gland (insufficient production of thyroid-stimulating hormone) and hypothalamus (impaired thyroliberin synthesis). Nonspecific clinical manifestations of hypothyroidism are the reason for examining the patient for thyroid hormone levels in primary care. Primary hypothyroidism screening is a common clinical situation in the general practitioner`s practice. According to Guideline 00514. Hypothyroidism of the Finnish Medical Research Society Duodecim Medical Publications Ltd, the use of which is approved by the Order of the Ministry of Health of Ukraine № 1422 of December 29, 2016, diagnosis of hypothyroidism and treatment of primary hypothyroidism are the tasks of primary care professionals. Decreased thyroid function may have subclinical and manifest forms, which are detected in the analysis of the results of thyroid hormones and clinical signs of the disease, require different treatment approaches. There are the differences in the use of levothyroxine replacement therapy in patients of different ages and depending on the causes of hypothyroidism. Patients under 55 years old are prescribed levothyroxine sodium in a daily dose of 1,6–1,8 μg/kg body weight. In patients over 55 years old, the daily requirement of levothyroxine sodium is calculated at 0,9 μg/kg body weight, taking into account existing cardiovascular disease. If patients are obese, the calculation is made on the «ideal» weight. The calculation of the dose and rules of levothyroxine sodium prescription in primary care are presented on the example of four clinical cases. The algorithm for control levothyroxine replacement therapy in patients with primary hypothyroidism is also presented.

Body Weight as a Major Determinant Section of Thyroxine Sodium Dosage in the Treatment of Primary Hypothyroidism

Introduction: Several formulae have been proposed for optimising the dosage prerequisites of levothyroxine (LT4), and body weight and Body Mass Index (BMI) have been suggested to broadly dependent on the formulae range. Aim: To evaluate the role of body weight as a determinant of LT4 dosage in the treatment of primary hypothyroidism. Materials and Methods: The present study was a prospective observational study conducted at Outpatient Department (OPD) Endocrinology, Patna Medical College Hospital, Patna, Bihar, India, on 100 patients diagnosed with untreated primary hypothyroidism between February 2020 and January 2021. Demographic details, anthropometric measurements, vital signs, and details of types and dosage of treatment received were collected. LT4 dose requirement for each individual patient was then generated as mcg per kg/body weight per day. Estimation of serum Thyroid Stimulating Hormone (TSH), FT4, creatinine and thyroid peroxidase levels were carried out as per standard diagnostic protocols and the dosage adjustment was conducted based on target TSH levels. Population characteristics were expressed as mean±standard deviation. The Python version 3.4.5 with the package seaborn was used for statistical analyses and preparation of figures, distribution and correlation plots. Results: The study enrolled 100 individuals (88 women and 12 men) with mean age of 40.69 years (age range 17 to 72 years). A significant positive correlation was noted between the LT4 dose and total body weight (p-value <0.001). The association was also significant when the LT4 dose was correlated with BMI (p-value <0.001) and FT4 (p-value <0.001). However, the correlation of Thyroid Peroxidase Antibodies (TPO Ab), TSH, height and age with the LT4 daily dose (p-value >0.05) was found to be statistically non significant. Conclusion: There exist a significant positive correlation between LT4 dosage and body weight. Hence, body weight should be considered as a key determinant while prescribing LT4 therapy for the treatment primary hypothyroidism.

Desiccated Thyroid Extract Versus Synthetic LT4/T3 Combination Versus LT4 Monotherapy in the Treatment of Primary Hypothyroidism With Special Attention to the Thr92AlaD2 Polymorphism. With Special Attention to the Gene Polymorphism

Introduction: Before the availability of levothyroxine (LT4), patients were treated with desiccated thyroid extract (DTE). When switching from DTE to LT4, despite adequate dosing based on serum TSH levels, some patients still feel unwell with fatigue, mental fogginess, weight gain etc. A recent randomized, crossed over study between DTE vs. LT4 conducted in our department showed that once-daily DTE caused modest weight loss and possible improvement in mental health scores without appreciable adverse effects; also, nearly half of the study patients preferred DTE over LT4. A few studies have shown that LT4/T3 combination had beneficial effects in improving quality of life relative to LT4 alone. Furthermore, it has been reported that patients with CC genotype in the deiodinase type 2 polymorphism responded more favorably with LT4/T3 combination than T4 monotherapy. Hypothesis: This study investigated the efficacy and effectiveness of DTE vs. LT4/T3 combination vs. LT4 monotherapy in hypothyroid patients based on genotypic differences of deiodinase type 2. Methodology: This was a prospective, randomized, double-blind, crossover study. 75 subjects completed the study. There were 3 arms: DTE, LT4+T3 combination, and LT4 alone. Each subject was randomly allocated to one of these 3 arms for 12 weeks randomly. The study was powered to detect the primary outcome. The primary endpoint was post-treatment score on the 36-point thyroid symptom questionnaire. Secondary endpoints were weight, general health questionnaire, the Beck depression inventory, Wechsler Memory testing, lipid panels and thyroid function tests. Analysis was performed with a linear mixed model using subject as a random factor and group as a fixed effect. Results: There was no significant difference between the 3 arms on the thyroid symptom questionnaire (p=.32), and the secondary outcomes showed no between group differences. Auditory memory index (p=.008), and visual working memory index (p=.02) were higher in the Hashimoto’s than non-Hashimoto’s group. There was no significant primary or secondary outcome difference among various genotypes of deiodinase 2. There was no relationship between Hashimoto’s vs. non-Hashimoto’s based on genotypes or likelihood of carrying Thr92AlaD2 polymorphism. Though there was no statistically significant preference for any treatment, numerically more patients with Hashimoto’s preferred DTE and LT4/T3 combination than LT4-monotherapy. Conclusions: There was no significant difference between hypothyroid patients taking DTE vs. LT4/T3 combination vs. LT4 monotherapy. Numerically, Hashimoto’s patients tended to prefer DTE and LT4/T3 combination. Also, there was no observed relationship between Hashimoto’s and polymorphism. Further studies with more patients may be needed.

Pituitary Hyperplasia Secondary to Primary Hypothyroidism Mimicking a Macroadenoma With Optical Chiasm Compression

Background: A long term untreated primary hypothyroidism can stimulate thyrotropes proliferation, leading to pituitary hyperplasia. This condition is known as pituitary hyperplasia secondary to primary hypothyroidism (PHPH). It is a rare condition that mimics pituitary adenoma and can achieve large proportions with optic chiasm compression. A misdiagnosis may be catastrophic, and a pituitary resection wrongly performed. Clinical Case: A 25-year-old woman with a medical history of delayed neuro psychomotor development and epilepsy due to congenital CNS malformation had a Brain MRI performed for epilepsy follow-up three years earlier. At that time, neuroimaging had shown a pituitary enlargement, and laboratory data were diagnostic of severe primary hypothyroidism with TSH of 290.6 uUI/mL (normal range 0.4 to 4.5 uUI/mL) and T4L <0.23 ng/dL (normal range: 0.9 to 1.8 ng/dL). She then had received a 75 mcg levothyroxine prescription. However, the patient missed medical follow-up and returned three years later, when sella turcica MRI showed a 0.9x1.0x1,4 cm pituitary lesion, consistent with a macroadenoma with suprasellar extent near the optic chiasm. Because of the cognitive impairment, the patient was not able to complete the visual field test. Neurology service referred the patient to endocrinology evaluation for surgical treatment. Hypothyroidism was still uncontrolled with TSH 157.1 uUI/mL and T4L 0.28 ng/dL. We had adjusted the levothyroxine dose to 125 mcg and advised adherence. Subsequent thyroid function tests had shown TSH 6.91 uUI/mL and T4L 1.15 ng/dL. After thyroid function stabilization, the patient performed a new sella turcica MRI, which had not evidenced pituitary lesion. Pituitary hyperplasia secondary to primary hypothyroidism was her final diagnosis. Conclusion: This case report illustrates the importance of the correct diagnosis and treatment of PHPH. Levothyroxine replacement, with TSH normalization, reverses the gland hyperplasia within 2 to 4 months.

Levothyroxine Therapy in Thyrodectomized Patients.

Administration of the optimal dose of levothyroxine (LT4) is crucial to restore euthyroidism after total thyroidectomy. An insufficient or excessive dosage may result in hypothyroidism or thyrotoxicosis, either one associated with a number of symptoms/complications. Most literature regarding the LT4 dosage deals with the treatment of primary hypothyroidism, whereas a limited number of studies handle the issue of thyroxin replacement after total thyroidectomy. A literature review was performed focusing on all papers dealing with this topic within the last 15 years. Papers that reported a scheme to calculate the proper LT4 dose were collected and compared to set up a review exploring limits and drawbacks of LT4 replacement therapy in the wide population of patients who had undergone thyroidectomy. Most of the methods for monitoring and adjusting thyroid hormone replacement after thyroidectomy for benign disease use LT4 at an empirical dose of approximately 1.6 μg/kg, with subsequent changes according to thyroid function test results and assessments of the patient’s symptoms. Approximately 75% of patients require a dose adjustment, suggesting that factors other than body weight play a role in the determination of the proper LT4 dose. Hence, several schemes are reported in the literature for the proper initial dose of LT4. An inadequate level of thyroid hormone levels in these patients can be due to several factors. The most common ones that lead to the necessity of LT4 dose adjustments include lack of compliance, changes in LT4 formulation, dosage errors, increased serum levels of T4-binding globulin, body mass changes, and dietary habits. Moreover, concomitant ingestion of calcium supplements, ferrous sulfate, proton-pump inhibitors, bile acid sequestrants, and sucralfate might influence LT4 absorption and/or metabolism. Furthermore, some gastrointestinal conditions and their treatments can contribute to suboptimal LT4 performance by altering gastric acidity and thereby reducing its bioavailability, particularly in the solid form. Beyond the classic tablet form, new formulations of LT4, such as a soft gel capsule and an oral solution, recently became available. The liquid formulation is supposed to overcome the food and beverages interference with absorption of LT4 tablets.

CASE REPORT – ACUPUNCTURE TREATMENT IN FEMALE PATIENT PRESENTED WITH PRIMARY HYPOTHYROIDISM

Primary hypothyroidism occurs due to increased thyroid-stimulating hormone (TSH). Most commonly it’s autoimmune and results from Hashimoto’s thyroiditis, which is also often associated with a firm goiter. In the primary hypothyroidism, the thyroid is being stimulated properly, but it’s not able to produce enough thyroid hormones so the body can function normally. This means that the source of the problem is the thyroid itself. In this research is presented a case of a 33 year old woman diagnosed with primary hypothyroidism. The patient has done 34 acupuncture treatments in a period of 8 months. After 6 months of starting the treatment the patient medicament therapy with Euthirox was ended. The anti-TPO levels were decreased from 425 to 70.3 IU/ml and the TSH and fT4 levels were effectively kept within the normal range. Acupuncture treatment as part of the Traditional Chinese Medicine can be exceptionally effective in the treatment of primary hypothyroidism, although as a treatment for autoimmune disease it takes more time to see the positive results. Considering that it is an autoimmune and chronic disease, treatment also requires a long-term approach. The patient’s condition will be monitored and treatments will be continued until complete normalization of the anti-TPO levels.

ИЗОЛИРОВАННЫЙ ГИДРОПЕРИКАРД − СЛЕДСТВИЕ ПОЗДНЕЙ ДИАГНОСТИКИ ПЕРВИЧНОГО ГИПОТИРЕОЗА

Background. In therapeutic practice the diagnostics of hypothyroidism can be difficult due to its non-specific&nbsp;nature and symptoms diversity.&nbsp;Goal. To present the result of successful diagnostics and treatment of primary hypothyroidism, where&nbsp;hydropericardium was defined as the main symptom of the disease.Material and methods. A case of late diagnosis of primary hypothyroidism in a female aged 50 with hydropericardium&nbsp;is described. The tactics of examination of the patient according to the recommendations of the European Society of&nbsp;Cardiology (2015) with the purpose of excluding metabolic causes of pericardial effusion is presented.Results. The ignoring of the most frequent symptoms of hypothyroidism was found to be the reason for late&nbsp;diagnostics of the disease, hydropericardium being considered the primary disease.Conclusions. In order to exclude metabolic causes of pericardial effusion during the examination of patients with&nbsp;the diseases of pericardium, evaluation of the thyroid function is warranted.

Timing of Levothyroxine in the Treatment of Primary Hypothyroidism

Timing of Levothyroxine in the Treatment of Primary Hypothyroidism

Time bound regression of pituitary hyperplasia in primary pituitary hypothyroidism following treatment

Aim: The aim was to prospectively study radiological regression of pituitary hyperplasia following the treatment for primary hypothyroidism by serial magnetic resonance imaging (MRI). Subjects and Methods: Seven patients (1 male and 6 females) with profound hypothyroidism were included, age ranging from 13 to 42 years. MRI for pituitary was done at first visit and on follow-up. Pituitary size on imaging was matched with baseline T3, T4, thyroid-stimulating hormone (TSH), and thyroid peroxidase antibody antibodies and TSH on follow-up. Results: By 6 weeks all patients showed clinical improvement with near normalization of thyroid function tests in most patients. The TSH normalization was well correlated with regression of the pituitary enlargement on imaging at 6 weeks. The height of pituitary gland at baseline was 13.24 ± 3.61 mm, at first follow-up 9.68 ± 1.32 mm, and at second follow-up 7.80 ± 3.95 mm. The diameter of the pituitary gland at baseline was 14.47 ± 4.14 mm, at first follow-up 11.83 ± 3.99 mm, and at second follow-up 7.25 ± 4.59 mm. The height of the pituitary gland significantly reduced in first and second follow-up ( P P Conclusion: Pituitary hyperplasia secondary to primary hypothyroidism regresses with treatment within 6 weeks of initiation of treatment in its height however, it takes months for reduction in the diameter of the gland. We recommend repeat imaging in enlarged and homogenously enhancing pituitary gland in patients of primary hypothyroidism at 6 weeks of initiation of treatment to prove or disprove hyperplasia.

Abstract #1059: Timing of Levothyroxine in the Treatment of Primary Hypothyroidism

Abstract #1059: Timing of Levothyroxine in the Treatment of Primary Hypothyroidism

Changes in Body Weight after Treatment of Primary Hypothyroidism with Levothyroxine

Surprisingly few studies have examined weight change in hypothyroid patients after initiation of levothyroxine (LT4) therapy. Our study aimed to investigate weight change after initiation of LT4 treatment for primary hypothyroidism. Using electronic medical records from Boston Medical Center, Boston, Massachusetts, we performed a retrospective cohort study between January 1, 2003, and February 1, 2011. Adults ≥18 years of age with newly diagnosed primary hypothyroidism with an initial thyroid-stimulating hormone (TSH) level ≥10 mIU/L were identified. Patients with postsurgical hypothyroidism, thyroid cancer, and a history of radioactive iodine or head/neck irradiation, congestive heart failure, anorexia nervosa, end-stage renal disease, cirrhosis, pregnancy, or use of prescription weight-loss medications were excluded. TSH and weight at diagnosis and up to 24 months after LT4 initiation were collected. Weight change was assessed at the first posttreatment serum TSH level <5 mIU/L. A total of 101 patients (mean age, 48 ± 15 years; 71% women) were included. Initial median TSH was 18.3 mIU/L (range, 10.1 to 710.5 mIU/L) and initial median weight was 79.6 kg (range 41.5 to 167.5 kg). Posttreatment median TSH level was 2.3 mIU/L (range, 0.04 to 5 mIU/L), and weight change at a median of 5 months (range, 1.1 to 25.6 months) was -0.1 kg (range, -20.6 to 7.7 kg). Initial median body mass index (BMI) of 95 of the patients was 29.3 kg/m2 (range, 19.5 to 56.1 kg/m2), and the median change in BMI was -0.1 kg/m2 (range, -7.1 to 3.3 kg/m2). Only 52% of patients lost weight, with a mean weight loss of 3.8 ± 4.4 kg. Gender, race, education, insurance type, age, initial TSH level, time to normalization of TSH, and initial weight were not associated with changes in weight or BMI. Contrary to popular belief, our study of 101 patients with primary hypothyroidism showed that no significant weight change occurs after initiation of LT4 treatment.

Effect of levothyroxine in the treatment of primary hypothyroidism

Objective To explore the influence of levothyroxine(L-T4) in the treatment of primary hypothyroidism on myocardial enzymes and lipids.Methods 78 patients with primary hypothyroidism were selected and treated with L-T4 for 12 weeks.The fasting serum levels promote thyroid hormone(TSH),free T3 (FT3),free T4 (FT4),total cholesterol (TC),triglycerides (TG),low-density lipoprotein cholesterol (LDL-C),aspartate aminotransferase enzyme (AST),creatine kinase (CK) and its isoenzyme (CK-MB),lactate dehydrogenase(LDH) were monitored and analyzed before and after treatment.Results After L-T4 treatment for 12 weeks,compared with before treatment,TSH,TC,TG,LDL-C,CK,CK-MB,LDH,AST were significantly decreased or restored (t =10.5223,26.8498,22.7699,16.2735,22.9329,13.1910,32.0907,22.9597,all P ＜ 0.01).The FT3 was negatively correlated with TG (r =-0.3782),LDL-C(r =-0.3506),AST(r =-0.2843),LDH(r =-0.2974),CK(r =-0.3726) (all P ＜ 0.01)and CK-MB(r =-0.2559) (P ＜ 0.05).FT4 was negatively correlated with TC (r =-0.2660),TG (r =-0.4661),LDL-C(r=-0.5119),LDH(r=-0.5936),CK(r=-0.4877),CK-MB(r=-0.5463) (all P＜0.01)and AST(r =-0.2328) (P ＜0.05).TSH was positively correlated with TC(r =0.5341),TG(r =0.7567),LDL-C(r =0.8240),AST (r =0.3923),LDH (r =0.8073),CK (r =0.9661),CK-MB (r =0.7336) (all P ＜0.01).TSH had,the best correlationship with CK (r =0.9661).Conclusion L-T4 can significantly improve the thyroid function and reduce the blood lipids,myocardial enzymes levels of patients with primary hypothyroidism. Key words: Hypothyroidism ; Thyroxine ; Myocardium enzymes; Lipids

A case of a naturally conceived pregnancy associated with multiple ovarian cysts in a patient with severe untreated primary hypothyroidism

There are few reports of multiple ovarian cysts secondary to hypothyroidism, and multiple ovarian cysts associated with pregnancy most commonly occur in association with assisted reproductive technologies. Herein, we report a case of a naturally conceived pregnancy occurring 2 years after stopping treatment for primary hypothyroidism. The patient developed multiple ovarian cysts in the first trimester, and laboratory studies and ultrasonography were consistent with hypothyroidism. Herein, we present the case and discuss the importance of prenatal screening for hypothyroidism.

Treatment for primary hypothyroidism: current approaches and future possibilities

Primary hypothyroidism is the most common endocrine disease. Although the diagnosis and treatment of hypothyroidism is often considered simple, there are large numbers of people with this condition who are suboptimally treated. Even in those people with hypothyroidism who are biochemically euthyroid on levothyroxine replacement there is a significant proportion who report poorer quality of life. This review explores the historical and current treatment options for hypothyroidism, reasons for and potential solutions to suboptimal treatment, and future possibilities in the treatment of hypothyroidism.

Hypothyroidism and Subclinical Hypothyroidism in the Older Patient

To review the etiology, precipitating factors, clinical findings, screening recommendations, and treatment for primary hypothyroidism and subclinical hypothyroidism in the older patient. A PubMed search of English language articles using a combination of words: elderly, thyroid, hypothyroid,* subclinical hypothyroid,* etiology, screening, diagnosis, and treatment to identify original studies, guidelines, and reviews on primary hypothyroidism and subclinical hypothyroidism published between 1979 and present. Overall, 51 clinical reviews, original studies, references, and guidelines were obtained and evaluated on their clinical relevance to the older patient population. The literature included guidelines and considerations for the diagnosis, screening, and management of subclinical and overt primary hypothyroidism in the older patient. Females and individuals 60 years of age or older have a higher prevalence of primary hypothyroidism and subclinical hypothyroidism. While screening recommendations exist, the need or suggested age to initiate screening varies among organizations. TSH and free T4 values are used for diagnosing and monitoring. Levothyroxine remains the drug of choice for replacing endogenous thyroid hormone. Despite evidence to suggest its need, the treatment of subclinical hypothyroidism remains controversial.

Low-Normal or High-Normal Thyrotropin Target Levels During Treatment of Hypothyroidism: A Prospective, Comparative Study

Recent literature advocates the decrease of the upper limit of the normal thyrotropin (TSH) reference range. The objective of this study was to determine whether treated hypothyroid patients maintained within a low-normal TSH range (0.4-2.0 mIU/L) have better clinical outcomes than those maintained within a high-normal TSH range (2.0-4.0 mIU/L). The study was performed in a thyroid outpatient clinic of a tertiary hospital. This was a prospective, interventional study. Forty-two participants with newly diagnosed overt primary hypothyroidism were paired in two groups: group 1 (n=20), low-normal target TSH; group 2 (n = 22), high-normal target TSH. Levothyroxine was initiated, and dose was adjusted to achieve and sustain the target TSH value during the study period. After the target TSH was reached, participants were evaluated every 3 months for thyroid function, serum lipid profile, resting energy expenditure (REE), body composition, and bone mineral density, for 12 months. Nineteen patients in group 1 and 16 in group 2 completed the study. In the whole-group analysis, total cholesterol (p = 0.01), low-density lipoprotein cholesterol (p = 0.004), and triglycerides (p < 0.001) decreased after treatment, whereas REE per kilogram of lean body mass (p = 0.001) and total fat body mass (p =0.02) increased. Group 1 patients had a significantly higher relative increase in REE (+7.1% ± 11.3% vs. +3.6% ± 15.1%, p = 0.02). There was no difference between the groups in the other variables. Despite recent trends toward lowering the upper limit of normal TSH range, the results of this 12-month study provided no substantial clinical evidence to corroborate that treatment of primary hypothyroidism should aim at maintaining TSH levels in a low-normal range

Combined therapy with L-Thyroxine and L-Triiodothyronine compared to L-Thyroxine alone in the treatment of primary hypothyroidism

The objective of this study was to compare various parameters in patients with hypothyroidism receiving either monotherapy with L-thyroxine (L-T4) or combination therapy with L-T4 and L-triiodothyronine (L-T3). We conducted a randomized, controlled trial in 36 premenopausal women with hypothyroidism. The patients were divided into two groups: Group A (n=20) received only L-T4, while Group B received the combination L-T4 and L-T3. The treatment period lasted for 6 months. At baseline, the various parameters examined did not differ in the two groups. No significant difference between monotherapy and combined therapy was demonstrated on TSH level, ECG monitoring, densitometry, or thyroid symptoms score. The lipid profile was better during combined treatment compared to L-T4 alone; in Group A during treatment with L-T4 the levels of cholesterol and low density lipoprotein (LDL) cholesterol were unchanged, while in group B total cholesterol and LDL decreased (p<0.05). The changes in osteocalcin levels did not differ in the two groups, whereas the levels of urine deoxypyridinoline at the end of therapy were higher in the group with combination therapy, compared to monotherapy. Compared with L-T4 alone, replacement therapy with the combination of L-T4+L-T3 shows favourable changes in serum lipid profile, but higher activation of bone resorption.