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Hypothyroidism

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

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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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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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