Hypothyroidism

Chaker, Layal; Bianco, Antonio C.; Jonklaas, Jacqueline; Peeters, Robin P.

doi:10.1016/s0140-6736(17)30703-1

Cited by 880 publications

(948 citation statements)

References 145 publications

(91 reference statements)

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“…According to the sensitivity analysis, a higher prevalence of subclinical and total hypothyroidism was found for studies using lower TSH reference values. The most commonly cited reference range for TSH concentration in the clinical literature set the highest limit at 4.0 mIU/L (and the lowest limit at 0.4 mIU/L), while the reference range for fT 4 depends on the type of assay and the population in question [1]. Nevertheless, the reference level cutoffs used to determine overt and subclinical hypothyroidism have changed over the years [46].…”

Section: Discussionmentioning

confidence: 99%

“…Overt hypothyroidism is the combination of an elevated level of serum thyroid-stimulating hormone (TSH) with a decreased level of serum free thyroxin (fT 4 ) as compared to the reference ranges in the general population. Subclinical hypothyroidism is defined as an elevated serum TSH level in combination with a normal serum fT 4 level [1, 2]. The reference ranges for TSH and fT 4 currently used to define thyroid dysfunction are subject of discussion because of the arbitrary nature of the cutoffs.…”

Section: Introductionmentioning

confidence: 99%

“…The reference ranges for TSH and fT 4 currently used to define thyroid dysfunction are subject of discussion because of the arbitrary nature of the cutoffs. This issue is of clinical importance for diagnosis and treatment decision purposes [1, 3]. …”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Undiagnosed Hypothyroidism in Europe: A Systematic Review and Meta-Analysis

Mendes

Alves

Silverio³

et al. 2019

Eur Thyroid J

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Background: Patients with undiagnosed hypothyroidism are not treated for the disease and are at high risk of developing serious complications, with major impact on public health. There is a need to systematically review the available evidence on this topic. Objective: To identify the prevalence of undiagnosed hypothyroidism in Europe. Methods: A systematic review of the literature (Medline, EMBASE, and Cochrane Central) was performed to identify epidemiological studies on the prevalence of undiagnosed hypothyroidism among European populations published between January 2008 and April 2018. The Newcastle-Ottawa Scale was used to assess the methodological quality of the included studies. Random-effects meta-analyses were performed to pool estimates of proportions (with 95% confidence intervals [CIs]) of undiagnosed (1) subclinical, (2) overt, and (3) total hypothyroidism. Results: The search returned 15,565 citations (4,526 duplicates). Twenty papers were included in the study. Fourteen and 6 studies were of good and moderate methodological quality, respectively. The results of the meta-analyses were as follows for the prevalence of undiagnosed hypothyroidism: subclinical, 4.11% (95% CI 3.05–5.31%, I² = 99.32%); overt, 0.65% (95% CI 0.38–0.99%, I² = 96.67%); and total, 4.70% (95% CI 2.98–6.79%, I² = 99.53%). According to the sensitivity analysis, the prevalence of hypothyroidism tends to be higher in female patients, in those aged ≥65 years, among studies with lower sample sizes, in those with thyroid-stimulating hormone levels <4.5 mIU/L, and in Eastern and Southern Europe. Conclusions: The current evidence suggests that a considerable proportion of the European population has hypothyroidism, particularly subclinical hypothyroidism, which is undiagnosed. This issue deserves further investigation because of possible deleterious consequences for public health.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence of Undiagnosed Hypothyroidism in Europe: A Systematic Review and Meta-Analysis

Mendes

Alves

Silverio³

et al. 2019

Eur Thyroid J

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“…In the majority of cases, SH in this context is transient. On the other hand, radioactive iodine (RAI) treatment leads to permanent overt hypothyroidism in 55 and 80% of patients with toxic nodular goiter and Graves' disease, respectively [32]. Persistent hypothyroidism secondary to external beam radiotherapy (EBRT) of the neck occurs in 20-30% of cases, with a peak incidence after 2-3 years [33]; the risk of post-EBRT hypothyroidism increases with increasing radiation dose [34].…”

Section: Confirm the Persistent Nature Of The Patient's Tsh Elevationmentioning

confidence: 99%

Subclinical hypothyroidism: new trials, old caveats

Lamine¹,

Giorgi²,

Marino³

et al. 2018

Hormones

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The indications for levothyroxine replacement therapy for subclinical hypothyroidism (SH) remain a subject of debate, especially when prescribed for older adults. The results of the recent TRUST trial indicate that levothyroxine does not improve clinical symptom scores among elderly patients with SH. While there is much concern regarding the dilemma of introducing or withholding levothyroxine, less attention may be paid to the differential diagnosis of an elevated TSH level, which is the prerequisite for diagnosing SH. Herein, we review these issues facing endocrinologists and internists/generalists either in practice or in training. When a patient presents abnormal thyroid test results compatible with SH, a series of issues need to be addressed before the implementation of replacement therapy is considered: first, an isolated TSH elevation not linked to a primary thyroid pathology should be excluded; second, the persistent nature of the patient's TSH elevation and SH profile should be verified; third, SH symptoms and potential complications relevant for the specific patient should be documented; fourth, expectations from levothyroxine substitution therapy for SH in the specific patient should be clarified. Only then can the decision be made whether levothyroxine substitution should be introduced or not.

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“…1 Constitutional symptoms include fatigue/drowsiness, proximal myopathy, cold intolerance, constipation and decreased appetite. 2 Xerosis remains most common cutaneous finding followed by pallor, nail changes, alopecia and madarosis. 1 Puffy edema, pruritus, decreased sweating and ivory yellow skin has been reported in other studies.…”

Section: Introductionmentioning

confidence: 99%

Conundrums of hypothyroidism

Kharkar¹,

Naskar²

2018

Int J Res Dermatol

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<p class="abstract">A 46 year old female came with complaints of dryness of skin and severe hair loss since 2-3 years. There was history of intermittent low grade fever, swelling all over body since 1 year; patient also complained of tingling numbness over bilateral legs and forearms along with difficulty in swallowing food. On further probing, history of difficulty in lifting arms above the head, constipation, generalised fatigue and drowsiness could be elicited. Patient also noticed raised skin coloured asymptomatic lesions over buttocks. On examination loss of eyebrows and alopecia in frontal and parietal scalp was seen. There was prominent follicular ostia and atrophy on scalp and body. Depressed keratotic papules with a generalized doughy feel of skin was appreciated all over body. A differential diagnosis of connective tissue disorder, widespread alopecia areata, folliculotropic mycosis fungoides, hypothyroidism and atopic dermatitis was made. Laboratory investigations revealed a low T3, T4 with a significantly raised TSH suggestive of a primary hypothyroidism. On histopathology mucin deposition in papillary and mid dermis was seen along with non-scarring pattern of alopecia. A diagnosis of hypothyroidism was made and patient was started on Tab. levothyroxin 75 micrograms once daily for 4 months along with hematinics, multivitamins and calcium supplements. Regular and frequent application of emollients was advised to the patient.</p>

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Hypothyroidism

Cited by 880 publications

References 145 publications

Prevalence of Undiagnosed Hypothyroidism in Europe: A Systematic Review and Meta-Analysis

Prevalence of Undiagnosed Hypothyroidism in Europe: A Systematic Review and Meta-Analysis

Subclinical hypothyroidism: new trials, old caveats

Conundrums of hypothyroidism

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