Real Practice Assessment of Persistent Symptoms After Initiation of Levothyroxine
Abstract
Objective Levothyroxine (LT4) is the standard treatment for hypothyroidism. However, certain patients experience persistent symptoms even after achieving euthyroid status with LT4 therapy. We aimed to determine the frequency of persistent or new symptoms in patients with hypothyroidism after initiating LT4.Methods This retrospective study included patients with hypothyroidism who started on LT4 between January 2017 and December 2019 at Mayo Clinic in Rochester, Minnesota, USA. Five hundred patient charts were randomly selected for review. Patients with at least 1 documented follow-up encounter after LT4 initiation were evaluated for ≤3 follow-up visits regarding their biochemical status and symptoms.Results We included 356 patients, a majority of whom were female (66.6%), white (92.3%), and obese (71.9%), with an average age of 59.5 years. At the baseline visit, approximately one-half of the patients (177/356, 47.7%) reported hypothyroid symptoms, with fatigue being the most common symptom. During the follow-up periods, we observed that 17.8% (28/157), 17.9% (19/106), and 19.3% (11/57) of patients had normal thyroid stimulating hormone (TSH) values but persistent symptoms, while 12.3% (19/156), 19.9% (16/107), and 8.9% (5/56) had normal TSH values but new symptoms. Overall, during each respective follow-up period, 26.7% (42/157), 27.3% (29/106), and 28% (16/57) of patients experienced persistent or new symptoms alongside normal TSH values, with fatigue being the most constant symptom.Conclusion Our findings indicate that approximately 1 in every 4 patients with hypothyroidism receiving LT4 therapy and achieving normal TSH levels experience persistent or new hypothyroid symptoms. The cause of these symptoms remains unclear, emphasizing the need for a better understanding of their underlying causes and the development of effective management strategies.
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Another study suggested that as many as one in four people receiving LT4 for hypothyroidism reported persistent hypothyroid-like symptoms on treatment.
“Another study suggested that as many as one in four people receiving LT4 for hypothyroidism reported persistent hypothyroid-like symptoms on treatment 14 .”
From A review of the safety of triiodothyronine in combination with levothyroxine for the management of hypothyroidism (2024) · cites this paper as [14]
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- Authors
- Hidalgo, J., Vallejo, B. A., Soto Jacome, C., Ayala, I. N., Cordova, S., Duran, M., Golembiewski, E., Toro-Tobon, D., & Brito, J. P.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Brito, Juan P.
- Venue
- Endocrine Practice
- Publisher
- Elsevier BV
- Published
- 2024-02
- Volume
- 30
- Issue
- 2
- Pages
- 95-100
- ISSN
- 1530-891X (ISSN-L)
- OpenAlex
- W4388086328
- Cited by
- 12
- References
- 22
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 3 · 2023: 1
- FWCI
- 2.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Endocrine Practice (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- hypothyroidism, levothyroxine, fatigue, thyroid-stimulating hormone, euthyroid status
- MeSH terms
- Fatigue, Female, Humans, Hypothyroidism, Male, Middle Aged, Retrospective Studies, Thyrotropin, Thyroxine
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