Italian association of clinical endocrinologists statement-replacement therapy for primary hypothyroidism: a brief guide for clinical practice
Abstract
Objective Hypothyroidism requires life-long thyroid hormone replacement therapy in most patients. Oral levothyroxine (LT4) is an established safe and effective treatment for hypothyroidism, but some issues remain unsettled. Methods The Italian Association of Clinical Endocrinologists appointed a panel of experts to provide an updated statement for appropriate use of thyroid hormone formulations for hypothyroidism replacement therapy. The American Association of Clinical Endocrinologists' protocol for standardized production of clinical practice guidelines was followed. Results LT4 is the first choice in replacement therapy. Thyroid-stimulating hormone (TSH) should be maintained between 1.0 and 3.0 mIU/L in young subjects and at the upper normal limit in elderly or fragile patients. Achievement of biochemical targets, patient well-being, and adherence to treatment should be addressed. In patients with unstable serum TSH, a search for interfering factors and patient compliance is warranted. Liquid or gel formulations may be considered in subjects with hampered LT4 absorption or who do not allow sufficient time before or after meals and LT4 replacement. Replacement therapy with LT4 and L-triiodothyronine (LT3) combination is generally not recommended. A trial may be considered in patients with normal values of serum TSH who continue to complain of symptoms of hypothyroidism only after co-existent nonthyroid problems have been excluded or optimally managed. LT3 should be administ…
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The Italian Endocrine Society and the Italian Association of Clinical Endocrinologists suggested that combination therapy could be considered.
“Most recently, the Italian Endocrine Society and the Italian Association of Clinical Endocrinologists have also suggested that combination therapy could be considered (21,22).”
From Short-Term Time Trends in Prescribing Therapy for Hypothyroidism: Results of a Survey of American Thyroid Association Members (2019) · cites this paper as [22]
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- Authors
- Guglielmi, R., Frasoldati, A., Zini, M., Grimaldi, F., Gharib, H., Garber, J. R., & Papini, E.
- Affiliations
- Ospedale Regina Apostolorum (IT)
- Santa Maria Nuova Hospital (IT)
- Ospedale Santa Maria della Misericordia di Udine (IT)
- Mayo Clinic (US)
- Corresponding author
- Papini, Enrico
- Venue
- Endocrine Practice
- Publisher
- Elsevier BV
- Published
- 2016-11
- Volume
- 22
- Issue
- 11
- Pages
- 1319-1326
- ISSN
- 1530-891X (ISSN-L)
- OpenAlex
- W2557346699
- Cited by
- 39
- References
- 32
- Citations by year
- 2025: 4 · 2024: 5 · 2023: 4 · 2022: 6 · 2021: 2 · 2020: 2 · 2019: 9 · 2018: 5 · 2017: 1 · 2016: 1
- FWCI
- 0.78
- 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
- primary hypothyroidism, thyroid hormone replacement, levothyroxine, medication adherence, elderly patients, pregnancy, quality of life
- MeSH terms
- Endocrinologists, Humans, Hypothyroidism, Societies, Medical, Thyrotropin, Thyroxine, Triiodothyronine, Practice Guidelines as Topic, Hormone Replacement Therapy
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