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Risks of suboptimal and excessive thyroid hormone replacement across ages.

U Feldt-Rasmussen1,2,3, G Effraimidis4,5,6, S Bliddal4

  • 1Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. ufeldt@rh.dk.

Journal of Endocrinological Investigation
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Summary

Optimizing levothyroxine (LT4) dosage for hypothyroidism is crucial. Both under- and over-treatment have severe health consequences across all age groups, necessitating greater healthcare and political attention.

Keywords:
HypothyroidismNon-communicable diseaseReplacementSuboptimal treatment

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Area of Science:

  • Endocrinology
  • Public Health

Background:

  • Hypothyroidism is a widespread non-communicable disease with significant preventable health impacts.
  • The condition affects individuals across all age groups, presenting unique challenges in diagnosis and management.

Purpose of the Study:

  • To review the consequences of suboptimal and excessive levothyroxine (LT4) replacement therapy in hypothyroidism.
  • To highlight the need for improved healthcare and political focus on managing this condition.

Main Methods:

  • This study employed a narrative review methodology.
  • The review synthesized existing literature on the effects of LT4 treatment across different age demographics.

Main Results:

  • Undertreatment in children can cause irreversible developmental issues, while in adults, it leads to impaired function and increased cardiovascular risk.
  • Excessive LT4 in adults is linked to cardiac mortality, osteoporosis, and psychological instability. In fertile women, it impacts fertility and pregnancy outcomes.
  • In the elderly, careful TSH assessment is vital to prevent overtreatment, which increases mortality risk.

Conclusions:

  • Suboptimal and excessive LT4 replacement for hypothyroidism leads to personally devastating and socioeconomically challenging consequences.
  • Increased focus from healthcare and political systems is required to mitigate these preventable outcomes of hypothyroidism.