A 6 dimensional approach to diagnosing refractory hypothyroidism
Open accessAbstract
Refractory hypothyroidism is a commonly encountered clinical challenge despite hypothyroidism being an easy condition to manage. However, truly refractory hypothyroidism accounts for only a small proportion of refractory hypothyroidism, remainder being “pseudo-refractory.” The 6-dimensional tool helps guide physicians to manage poorly controlled hypothyroid individuals better. This tool highlights some important aspects of evaluating such individuals such as dialogue, diagnosis, definition of endpoint, disturbance in assay, drug intake (L-thyroxine and concomitant drug intake), and comorbid disease. Most importantly, this simple reader friendly tool can help differentiate truly refractory from pseudo-refractory hypothyroidism. The latter being easily correctable holds the promise of improving the quality of life in such individuals.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Pathological causes of refractory hypothyroidism include obesity and gastrointestinal disorders that cause levothyroxine malabsorption, as well as rarer conditions such as nephrotic syndrome, Addison's disease, and cystic fibrosis.
“Pathological causes include obesity and gastrointestinal disorders responsible for LT4 malabsorption, as well as other rare conditions such as nephrotic syndrome, Addison's disease, and cystic fibrosis.4,17”
From Refractory hypothyroidism: unraveling the complexities of diagnosis and management (2023) · cites this paper as [17]
Cites
Shared decision making: A model for clinical practice
Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., Cording, E., Tomson, D., Dodd, C., Rollnick, S., et al. (2012) · Journal of General Internal Medicine · doi:10.1007/s11606-012-2077-6 · Cited by 4,405 · see citing works
Goodman and Gilman's The Pharmacological Basis of Therapeutics
FRAUNFELDER, F. T. (1981) · American Journal of Ophthalmology · doi:10.1016/0002-9394(81)90318-4 · Cited by 1,335 · see citing works
Thyroxine in Goiter, <i>Helicobacter pylori</i> Infection, and Chronic Gastritis
Centanni, M., Gargano, L., Canettieri, G., Viceconti, N., Franchi, A., Fave, G. D., & Annibale, B. (2006) · New England Journal of Medicine · doi:10.1056/nejmoa043903 · Cited by 329 · see citing works
Management of hypothyroidism in adults
Vaidya, B., & Pearce, S. H. S. (2008) · BMJ · doi:10.1136/bmj.a801 · Cited by 178 · see citing works
Gastrointestinal malabsorption of thyroxine
Virili, C., Antonelli, A., Santaguida, M. G., Benvenga, S., & Centanni, M. (2019) · Endocrine Reviews · doi:10.1210/er.2018-00168 · Cited by 164 · see citing works
Burch, H. B. (2019) · New England Journal of Medicine · doi:10.1056/nejmra1901214 · Cited by 164 · see citing works
Delayed Intestinal Absorption of Levothyroxine
BENVENGA, S., BARTOLONE, L., SQUADRITO, S., GIUDICE, F. L., & TRIMARCHI, F. (1995) · Thyroid · doi:10.1089/thy.1995.5.249 · Cited by 156 · see citing works
Aspects of the absorption of oral L-thyroxine in normal man
Wenzel, K. W., & Kirschsieper, H. E. (1977) · Metabolism · doi:10.1016/0026-0495(77)90121-4 · Cited by 151 · see citing works
Kaptein, E. M., Kaptein, J. S., CHANG, E. I., EGODAGE, P. M., Nicoloff, J. T., & Massry, S. G. (1987) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-65-4-606 · Cited by 55 · see citing works
Celiac disease and hypothyroidism
Collins, D., Wilcox, R., Nathan, M., & Zubarik, R. (2012) · The American Journal of Medicine · doi:10.1016/j.amjmed.2011.09.003 · Cited by 54 · see citing works
Treatment-refractory hypothyroidism
Ramadhan, A., & Tamilia, M. (2011) · Canadian Medical Association Journal · doi:10.1503/cmaj.110994 · Cited by 37 · see citing works
Effect of High-dose Biotin on Thyroid Function Tests: Case Report and Literature Review
Ardabilygazir, A., Afshariyamchlou, S., Mir, D. I., & Sachmechi, I. (2018) · Cureus · doi:10.7759/cureus.2845 · Cited by 23 · see citing works
Why are our hypothyroid patients unhappy? Is tissue hypothyroidism the answer?
Kalra, S., & Khandelwal, S. (2011) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/2230-8210.83333 · Cited by 21 · see citing works
Patient-centered management of hypothyroidism
Kalra, S., Agarwal, N., Aggarwal, R., Agarwal, S., Bajaj, S., Bantwal, G., Das, A., Ghosh, S. K., Gupta, P., Khandelwal, D., et al. (2017) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/ijem.ijem_93_17 · Cited by 13 · see citing works
Diagnosis and Management of Hypothyroidism: Addressing the Knowledge–Action Gaps
Kalra, S., Das, A. K., Bajaj, S., Saboo, B., Khandelwal, D., TIWASKAR, M. H., Agarwal, N., Gupta, P., Sahay, R. K., Aggarwal, S., et al. (2018) · Advances in Therapy · doi:10.1007/s12325-018-0744-7 · Cited by 11 · see citing works
Medication counseling for thyroxine
Kalra, S., Unnikrishnan, A., TIWASKAR, M. H., Sahay, R. K., Saboo, B., Negalur, V. B., Khandelwal, D., Gupta, P., Ghosh, S. K., Das, A., et al. (2017) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/ijem.ijem_91_17 · Cited by 6 · see citing works
Yamamoto, R., Kimura, S., & Ishizuki, Y. (1988) · Journal of Immunological Methods · doi:10.1016/0022-1759(88)90296-7 · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Refractory hypothyroidism: unraveling the complexities of diagnosis and management
Quiroz-Aldave, J. E., Concepción-Zavaleta, M. J., Durand-Vásquez, M. D. C., Concepción-Urteaga, L. A., Gamarra-Osorio, E. R., Suárez-Rojas, J., Rafael-Robles, L. D. P., Paz-Ibarra, J., & Román-González, A. (2023) · Endocrine Practice · doi:10.1016/j.eprac.2023.09.003 · Cited by 14 · see citing works
Practical and Pragmatic Usage of T3 in Hypothyroidism
Kalra, S., Dhingra, A., Kapoor, N., & Sahay, R. K. (2023) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/ijem.ijem_441_22 · Cited by 8 · see citing works
- Authors
- Narayanan, P., Kalra, S., & Monteiro, A. P. D. R.
- Affiliations
- Amrita Institute of Medical Sciences and Research Centre (IN)
- Bharti Hospital (IN)
- Corresponding author
- Narayanan, Prem
- ORCID
- Kalra, Sanjay
- Venue
- Thyroid Research and Practice
- Published
- 2020
- Volume
- 17
- Issue
- 2
- Pages
- 53
- ISSN
- 0973-0354 (ISSN-L)
- OpenAlex
- W3043483535
- Cited by
- 2
- References
- 17
- Citations by year
- 2023: 2
- FWCI
- 0.38
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc-sa
- Locations
- Thyroid Research and Practice (publishedVersion, cc-by-nc-sa)
- 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
- refractory hypothyroidism, hypothyroidism diagnosis, levothyroxine, drug interactions, comorbid diseases, treatment endpoints, quality of life
About these checks
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.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
