TY - JOUR

T1 - Consequences of undertreatment of hypothyroidism

AU - Feldt-Rasmussen, Ulla

AU - Effraimidis, Grigoris

AU - Bliddal, Sofie

AU - Klose, Marianne

N1 - Funding Information: U.F.R.’s research salary was sponsored by The Kirsten and Freddy Johansen’s Fund. S.B.’s research salary was sponsored by a grant from the Novo Nordisk Foundation (ID 0077221). Funding Information: U.F.R. has received speaker honoraria and travel grants from Merck, Darmstadt, Germany and Horizon, Maryland, USA. S.B. has received a speaker honorary from Merck, Darmstadt, Germany. Publisher Copyright: © 2023, The Author(s).

PY - 2024

Y1 - 2024

N2 - Purpose: To provide an overview of consequences of undertreatment with levothyroxine (LT4) in the common non-communicable disease, hypothyroidism. Methods: Narrative review of the literature. Results: Hypothyroidism is globally very prevalent at all age groups and represents a non-communicable disease in which the risks and consequences are preventable. In children and adolescents, the most devastating consequences of undertreatment are poor growth and development. Lack of early treatment in congenital hypothyroidism can lead to permanent damage of brain function. In young to middle-aged adults, consequences are often overlooked, and treatment delayed by many years. The resulting consequences are also at this age group compromised brain and physical functioning but less severe and partly reversible with treatment. The undertreated condition often results in a higher risk of several secondary devastating diseases such as increased cardiovascular disease burden, obesity, hypertension, poor physical capacity, poor quality of life. In young women of fertile age the consequences of undertreatment with LT4 are subnormal fertility, recurrent pregnancy loss, preeclampsia, compromised fetal growth and neurocognitive development. There is a further risk of 30–50% of developing postpartum thyroiditis. In the elderly population care must be given to avoid confusing a slightly high serum TSH as result of physiological age adaptation with a requirement for LT4 treatment in a truly hypothyroid patient. Conclusion: Undertreatment of the preventable non-communicable disease hypothyroidism requires more focus both from caretakers in the healthcare system, but also from the global political systems in order to prevent the personally devastating and socioeconomically challenging consequences.

AB - Purpose: To provide an overview of consequences of undertreatment with levothyroxine (LT4) in the common non-communicable disease, hypothyroidism. Methods: Narrative review of the literature. Results: Hypothyroidism is globally very prevalent at all age groups and represents a non-communicable disease in which the risks and consequences are preventable. In children and adolescents, the most devastating consequences of undertreatment are poor growth and development. Lack of early treatment in congenital hypothyroidism can lead to permanent damage of brain function. In young to middle-aged adults, consequences are often overlooked, and treatment delayed by many years. The resulting consequences are also at this age group compromised brain and physical functioning but less severe and partly reversible with treatment. The undertreated condition often results in a higher risk of several secondary devastating diseases such as increased cardiovascular disease burden, obesity, hypertension, poor physical capacity, poor quality of life. In young women of fertile age the consequences of undertreatment with LT4 are subnormal fertility, recurrent pregnancy loss, preeclampsia, compromised fetal growth and neurocognitive development. There is a further risk of 30–50% of developing postpartum thyroiditis. In the elderly population care must be given to avoid confusing a slightly high serum TSH as result of physiological age adaptation with a requirement for LT4 treatment in a truly hypothyroid patient. Conclusion: Undertreatment of the preventable non-communicable disease hypothyroidism requires more focus both from caretakers in the healthcare system, but also from the global political systems in order to prevent the personally devastating and socioeconomically challenging consequences.

KW - Age

KW - Levothyroxine

KW - Optimisation

KW - Thyroid function

KW - Treatment

U2 - 10.1007/s12020-023-03460-1

DO - 10.1007/s12020-023-03460-1

M3 - Review

C2 - 37556077

AN - SCOPUS:85167426645

VL - 84

SP - 301

EP - 308

JO - Endocrine

JF - Endocrine

SN - 1355-008X

IS - 2

ER -