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Medically not yet explained symptoms in hypothyroidism.

Laszlo Hegedüs1, Christina M Van Der Feltz-Cornelis2, Enrico Papini3

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Persistent symptoms, termed medically not yet explained symptoms (MNYES), are common in hypothyroidism. Recognizing MNYES can lead to better patient care than over-investigation or over-treatment.

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Area of Science:

  • Endocrinology
  • Internal Medicine
  • Psychosomatic Medicine

Background:

  • Persistent symptoms are prevalent in the general population and significantly more common in individuals with hypothyroidism.
  • Medically not yet explained symptoms (MNYES) are frequently encountered and preferred by patients, caregivers, and experts over other descriptors.
  • Endocrinologists may overlook MNYES or incorrectly attribute them to hypothyroidism, leading to suboptimal patient management.

Purpose of the Study:

  • To highlight the importance of recognizing medically not yet explained symptoms (MNYES) in patients presenting with unexplained symptoms.
  • To advocate for a shift from potentially harmful over-investigation and over-treatment of hypothyroidism towards effective MNYES management.
  • To define the crucial role of endocrinologists in acknowledging and managing MNYES.

Main Methods:

  • Literature review and synthesis of expert opinion on medically not yet explained symptoms (MNYES) in endocrinology.
  • Analysis of current diagnostic and treatment paradigms for unexplained symptoms in hypothyroid patients.
  • Framework development for a 'two-track approach' in managing MNYES, considering both physical and psychosocial factors.

Main Results:

  • Awareness of MNYES can facilitate more effective and less harmful interventions compared to current practices.
  • Effective endocrinologist engagement involves acknowledging MNYES, clear communication, and a balanced approach to physical and psychosocial contributors.
  • Patient categorization by symptom deterioration risk aids in tailoring therapeutic strategies.

Conclusions:

  • Endocrinologists must recognize and acknowledge medically not yet explained symptoms (MNYES) as a potential underlying cause of patient presentations.
  • A 'two-track approach' integrating physical and psychosocial aspects, alongside effective communication, is essential for managing MNYES.
  • Optimal management of MNYES requires dedicated time, specialized training, clinical expertise, and adequate healthcare resources.