Risks of suboptimal and excessive thyroid hormone replacement across ages

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.