Hypothyroidism

Roberts, Caroline GP; Ladenson, Paul W

doi:10.1016/s0140-6736(04)15696-1

Cited by 568Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryThyroid Cancer Diagnosis and Treatment

Hypothyroidism

Roberts, Caroline GP, Ladenson, Paul W·2004·The Lancet

DOI 10.1016/s0140-6736(04)15696-1

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Abstract

Hypothyroidism is common, potentially serious, often clinically overlooked, readily diagnosed by laboratory testing, and eminently treatable. The condition is particularly prevalent in older women, in whom autoimmune thyroiditis is common. Other important causes include congenital thyroid disorders, previous thyroid surgery and irradiation, drugs such as lithium carbonate and amiodarone, and pituitary and hypothalamic disorders. Worldwide, dietary iodine deficiency remains an important cause. Hypothyroidism can present with nonspecific constitutional and neuropsychiatric complaints, or with hypercholesterolaemia, hyponatraemia, hyperprolactinaemia, or hyperhomocysteinaemia. Severe untreated hypothyroidism can lead to heart failure, psychosis, and coma. Although these manifestations are neither specific nor sensitive, the diagnosis is confirmed or excluded by measurements of serum thyrotropin and free thyroxine. Thyroxine replacement therapy is highly effective and safe, but suboptimal dosing is common in clinical practice. Patient noncompliance, drug interactions, and pregnancy can lead to inadequate treatment. Iatrogenic thyrotoxicosis can cause symptoms, and, even when mild, provoke atrial fibrillation and osteoporosis. We summarise present understanding of the history, epidemiology, pathophysiology, and clinical diagnosis and management of hypothyroidism.

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Most recommend a reduced dose of 0.5 μg/kg/day in seniors (age >65 years).
“older people often require much lower doses to achieve euthyroidism, and most recommend a reduced dose of 0.5 µg/kg/day in seniors (age >65 years).1 62”
From Levothyroxine dose and risk of fractures in older adults: nested case-control study (2011) · cites this paper as [1]
The optimal levothyroxine dose for adults is 1.6-1.8 μg/kg/day.
“While the optimal levothyroxine dose for adults is 1.6-1.8 µg/kg/day,1 9”
From Levothyroxine dose and risk of fractures in older adults: nested case-control study (2011) · cites this paper as [1]
Older people often require much lower doses to achieve euthyroidism.
“older people often require much lower doses to achieve euthyroidism, and most recommend a reduced dose of 0.5 µg/kg/day in seniors (age >65 years).1 62”
From Levothyroxine dose and risk of fractures in older adults: nested case-control study (2011) · cites this paper as [1]

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Use Of Soy Protein Supplement And Resultant Need For Increased Dose Of Levothyroxine
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The fibrous variant of Hashimoto's thyroiditis
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Treatment of Myxedema Coma With Intravenous Thyroxine
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Self-citation
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Changes in Serum Triiodothyronine (T3) Kinetics after Prolonged Antarctic Residence: The Polar T3Syndrome*
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Multiple Effects of 5,5′-Diphenylhydantoin on the Thyroid Hormone System*
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Autosomal Dominant Transmission of Autoantibodies to Thyroglobulin and Thyroid Peroxidase*
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Hashimoto's Thyroiditis
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Fasting Decreases Thyrotropin Responsiveness to Thyrotropin-Releasing Hormone: A Potential Cause of Misinterpretation of Thyroid Function Tests in the Critically III*
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Changes in Thyroid Function in Euthyroid Subjects with a Family History of Graves' Disease: A Foliow-Up Study of 69 Patients*
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Anesthesia and Hypothyroidism
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Cranial irradiation and central hypothyroidism
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The Endocrine Manifestations of Hemochromatosis
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Prevalence of Anti-Thyroid Peroxidase Antibodies in Serum in the Elderly: Comparison with Other Tests for Anti-Thyroid Antibodies
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Thyroid Disease in Hemochromatosis
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SEXUAL MATURATION IN JUVENILE HYPOTHYROIDISM
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Factitious Elevation of Thyrotropin in a New Ultrasensitive Assay: Implications for the Use of Monoclonal Antibodies in “Sandwich” Immunoassay
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Effect of Rifampin Therapy on Thyroid Function Tests in a Hypothyroid Patient on Replacement <scp>L</scp>-Thyroxine
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PSYCHOTIC BEHAVIOR AS THE INITIAL INDICATOR OF ADULT MYXEDEMA
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Newer Insights into the Pathogenesis of Experimental Autoimmune Thyroiditis
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A Genome-Wide Scan for Autoimmune Thyroiditis in the Old Order Amish: Replication of Genetic Linkage on Chromosome 5q11.2-q14.3
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Myxedema Associated with Cardiac Tamponade
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Myxedema and ataxia
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Association of primary hypothyroidism and slipped capital femoral epiphysis
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THYROID HORMONES AND THE REGULATION OF THYROID FUNCTION IN MEN WITH COELIAC DISEASE
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Thyroid Dysfunction: Reproduction and Postpartum Thyroiditis
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Hyperprolactinemia, Infertility, and Hypothyroidism
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Anemia: A Cause of Intolerance to Thyroxine Sodium
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Cost Effectiveness of Screening for Subclinical Hypothyroidism in the Elderly
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Hypothyroxinemia and Phenytoin Toxicity: A Vicious Circle
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The Clinical Significance of Subclinical Thyroid Dysfunction
Biondi, B., & Cooper, D. S. (2008) · Endocrine Reviews · doi:10.1210/er.2006-0043 · Cited by 1,418 · see citing works
Prevalence of hypothyroidism in adults: an epidemiological study in eight cities of India.
Unnikrishnan, A., Kalra, S., Sahay, R., Bantwal, G., John, M., & Tewari, N. (2013) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/2230-8210.113755 · Cited by 422 · see citing works
Hypothyroidism as a Risk Factor for Cardiovascular Disease
Biondi, B., & Klein, I. L. (2004) · Endocrine · doi:10.1385/endo:24:1:001 · Cited by 411 · see citing works
Thyroid hormones states and brain development interactions
Ahmed, O. M., El‐Gareib, A. W., El-Bakry, A. M., El-Twab, S. M. A., & Ahmed, R. G. (2007) · International Journal of Developmental Neuroscience · doi:10.1016/j.ijdevneu.2007.09.011 · Cited by 339 · see citing works
A Review of the Clinical Consequences of Variation in Thyroid Function Within the Reference Range
Taylor, P. N., Razvi, S., Pearce, S. H., & Dayan, C. M. (2013) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-1315 · Cited by 274 · see citing works
Treatment with thyroid hormone
Biondi, B., & Wartofsky, L. (2014) · Endocrine Reviews · doi:10.1210/er.2013-1083 · Cited by 259 · see citing works
Thyrotropin and thyroid antibodies as predictors of hypothyroidism: a 13-year, longitudinal study of a community-based cohort using current immunoassay techniques
Walsh, J. P., Bremner, A. P., Feddema, P., Leedman, P. J., Brown, S. J., & O'Leary, P. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-1977 · Cited by 252 · see citing works
High Frequency of and Factors Associated with Thyroid Hormone Over-Replacement and Under-Replacement in Men and Women Aged 65 and Over
Somwaru, L. L., Arnold, A. M., Joshi, N., Fried, L. P., & Cappola, A. R. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-1696 · Cited by 239 · see citing works
Thyroid Diseases and Cerebrovascular Disease
Squizzato, A., Gerdes, V. E. A., Brandjes, D. P. M., Büller, H. R., & Stam, J. (2005) · Stroke · doi:10.1161/01.str.0000181772.78492.07 · Cited by 236 · see citing works
The International Society for the Study of Women's Sexual Health Process of Care for Management of Hypoactive Sexual Desire Disorder in Women
Clayton, A. H., Goldstein, I., Kim, N. N., Althof, S. E., Faubion, S. S., Faught, B. M., Parish, S. J., Simon, J. A., Vignozzi, L., Christiansen, K., et al. (2018) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2017.11.002 · Cited by 226 · see citing works
Thyroid hormone and breast carcinoma
Cristofanilli, M., Yamamura, Y., Kau, S., Bevers, T. B., Strom, S. S., Patangan, M., Hsu, L., Krishnamurthy, S., Theriault, R. L., & Hortobágyi, G. N. (2005) · Cancer · doi:10.1002/cncr.20881 · Cited by 219 · see citing works
How do autoimmune diseases cluster in families? A systematic review and meta-analysis
Cárdenas-Roldán, J., Rojas‐Villarraga, A., & Anaya, J. (2013) · BMC Medicine · doi:10.1186/1741-7015-11-73 · Cited by 217 · see citing works
Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee
Okosieme, O., Gilbert, J., Abraham, P., Boelaert, K., Dayan, C., Gurnell, M., Leese, G., McCabe, C., Perros, P., Smith, V., et al. (2016) · Clinical Endocrinology · doi:10.1111/cen.12824 · Cited by 208 · see citing works
Thyroid Dysfunction and Effects on Coagulation and Fibrinolysis: A Systematic Review
Squizzato, A., Romualdi, E., Buller, H. R., & Gerdes, V. E. A. (2007) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2007-0199 · Cited by 222 · see citing works
Hypothyroidism related to tyrosine kinase inhibitors: an emerging toxic effect of targeted therapy
Torino, F., Corsello, S. M., Longo, R., Barnabei, A., & Gasparini, G. (2009) · Nature Reviews Clinical Oncology · doi:10.1038/nrclinonc.2009.4 · Cited by 207 · see citing works
Myxedema Coma: A New Look into an Old Crisis
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Authors: Roberts, C. G., & Ladenson, P. W.
Affiliations: Johns Hopkins University (US)
Corresponding author: Ladenson, Paul W
ORCID: Roberts, Caroline GP
Ladenson, Paul W
Venue: The Lancet
Publisher: Elsevier BV
Published: 2004-03
Volume: 363
Issue: 9411
Pages: 793-803
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/s0140-6736(04)15696-1
OpenAlex: W4211152088
Cited by: 567
References: 163
Citations by year: 2026: 8 · 2025: 17 · 2024: 29 · 2023: 22 · 2022: 23 · 2021: 23 · 2020: 22 · 2019: 22 · 2018: 24 · 2017: 29 · 2016: 42 · 2015: 33 · 2014: 32 · 2013: 25 · 2012: 30
FWCI: 3.92
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Lancet (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, autoimmune thyroiditis, thyroid hormone replacement, thyrotoxicosis, lithium, amiodarone, iodine deficiency, hypercholesterolemia, hyperprolactinemia, hyperhomocysteinemia, hyponatremia, heart failure, pregnancy, older women, drug interactions
MeSH terms: Humans, Hypothyroidism, Thyroxine, Case-Control Studies, Randomized Controlled Trials as Topic

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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Hypothyroidism

Abstract

Integrity signals

Claims the paper makes

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Cites

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About these checks