Management of hypothyroidism in adults
Open accessAbstract
Hypothyroidism is one of the commonest chronic disorders in Western populations. In the United Kingdom, the annual incidence of primary hypothyroidism in women is 3.5 per 1000 and in men 0.6 per 1000.1 During 2006 12 million prescriptions for levothyroxine (50 μg or 100 μg tablets) were dispensed in England, equivalent to about 1.6 million people taking long term thyroid replacement therapy, about 3% of the population.2 The management of hypothyroidism is generally considered straightforward and is mostly carried out in primary care in the UK. Cross sectional surveys of patients taking levothyroxine have, however, shown that between 40% and 48% are either over-treated or under-treated.3 4 Furthermore, a small but significant proportion of patients continue to feel unwell despite taking levothyroxine.5 This review discusses current approaches in the management of hypothyroidism in adults. #### Sources and selection criteria We searched PubMed and the Cochrane Library databases for the keywords hypothyroidism and thyroxine. We identified further references from the original articles and recent review articles. We studied articles only in the English language, and gave priority to those published in the past 10 years and those reporting randomised controlled trials. #### Summary points
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The distribution of serum TSH reference interval is right-shifted with age, giving an upper 97.5% confidence interval of around 7.5 mU/L in healthy elderly people.
“the distribution of serum TSH reference interval is right -shifted with age, 24 -26 giving an upper 97.5% confidence interval of around 7.5 mU/L in healthy elderly people. 2,3”
From Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement (2023) · cites this paper as [3]
TSH is the most sensitive and earliest biochemical marker of hypothyroidism.
“The pituitary -derived TSH, due to its complex inverse association with the thyroid hormones (thyroxine and triiodothyronine), is the most sensitive and earliest biochemical marker of hypothyroidism. 2,3”
From Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement (2023) · cites this paper as [3]
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- Authors
- Vaidya, B., & Pearce, S. H. S.
- Affiliations
- Royal Devon and Exeter Hospital (GB)
- Royal Victoria Infirmary (GB)
- Corresponding author
- Vaidya, B.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2008-07-28
- Volume
- 337
- Issue
- jul28 1
- Pages
- a801-a801
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- OpenAlex
- W2013146329
- Cited by
- 178
- References
- 33
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 5 · 2023: 11 · 2022: 11 · 2021: 17 · 2020: 9 · 2019: 8 · 2018: 6 · 2017: 11 · 2016: 11 · 2015: 8 · 2014: 14 · 2013: 15 · 2012: 12
- FWCI
- 7.25
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- BMJ (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- 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, thyroid hormone replacement, primary hypothyroidism, overtreatment, undertreatment, hypothyroidism management, adults, primary care
- MeSH terms
- Adult, Chronic Disease, Female, Humans, Hypothyroidism, Male, Myocardial Infarction, Pregnancy, Pregnancy Complications, Reference Values, Referral and Consultation, Thyrotropin, Thyroxine
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