Persistent symptoms in euthyroid Hashimoto's thyroiditis: current hypotheses and emerging management strategies

Area of Science:

• Endocrinology
• Immunology
• Integrative Medicine

Background:

• Many patients with Hashimoto's thyroiditis (HT) experience persistent symptoms despite achieving normal thyroid hormone levels.
• Potential causes include altered thyroid hormone ratios and ongoing autoimmune activity.

Purpose of the Study:

• To review the mechanisms behind residual symptoms in HT.
• To evaluate current and emerging therapeutic strategies for improving patient outcomes.

Main Methods:

• Literature review of pathophysiological mechanisms and therapeutic interventions for persistent HT symptoms.
• Critical evaluation of medical, surgical, and complementary therapies.

Main Results:

• Levothyroxine (LT4) monotherapy escalation is not recommended. Combined LT4/liothyronine (LT3) therapy may help select patients.
• Total thyroidectomy shows promise for refractory symptoms but carries surgical risks. Selenium and vitamin D offer modest benefits.
• Traditional Chinese Medicine (TCM) shows potential as a complementary approach, requiring further research.

Conclusions:

• Understanding residual symptoms in HT is crucial for effective management.
• A multimodal approach, potentially including novel therapies and TCM, may improve patient-reported outcomes in HT.
• Further high-quality research is needed to validate emerging treatments for Hashimoto's thyroiditis.