Risks of suboptimal and excessive thyroid hormone replacement across ages
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Risks of suboptimal and excessive thyroid hormone replacement across ages. / Feldt-Rasmussen, U.; Effraimidis, G.; Bliddal, S.; Klose, M.
In: Journal of Endocrinological Investigation, Vol. 47, No. 5, 2024, p. 1083-1090.Research output: Contribution to journal › Review › Research › peer-review
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TY - JOUR
T1 - Risks of suboptimal and excessive thyroid hormone replacement across ages
AU - Feldt-Rasmussen, U.
AU - Effraimidis, G.
AU - Bliddal, S.
AU - Klose, M.
N1 - Funding Information: This is study was funded by Kirsten og Freddy Johansens Fond, Novo Nordisk Fonden, ID 0077221, Sofie Bliddal. Funding Information: UFR’s research salary was sponsored by The Kirsten and Freddy Johansen’s Fund. SB’s research salary was sponsored by a grant from the Novo Nordisk Foundation (ID 0077221). Publisher Copyright: © 2023, The Author(s).
PY - 2024
Y1 - 2024
N2 - Background: Hypothyroidism is prevalent at all ages and represents a non-communicable disease with preventable consequences. Method: Narrative review. Review: In children and adolescents, the most devastating consequences of undertreatment with levothyroxine (LT4) are poor growth and development. Delayed treatment in congenital hypothyroidism can lead to permanent brain damage. In young to middle-aged adults, symptoms are often overlooked, and treatment delayed by many years. The resulting consequences are also at this age group compromised brain and physical function but less severe and partly reversible with treatment. The under-treated condition often results in a higher risk of, e.g., increased cardiovascular disease burden, obesity, hypertension, poor physical capacity, and poor quality of life. Excessive replacement is at all adult age groups associated with increased risk of cardiac death, osteoporosis, loss of muscle function, psychological instability and poor quality of life. In young fertile women, the consequences of undertreatment with LT4 are subnormal fertility, recurrent pregnancy loss, compromised fetal growth, and neurocognitive development. On the other hand, excessive LT4 treatment has been related to gestational hypertension, preeclampsia and preterm birth. In the elderly, care must be given to avoid confusing a slightly high age-related serum TSH with requirement for LT4 treatment in a truly hypothyroid patient. Excessive LT4 treatment in patients of high age is associated with an increased mortality. Conclusion: Suboptimal and excessive LT4 replacement of the preventable non-communicable disease hypothyroidism requires more focus from the healthcare system and from the global political systems to prevent the personally devastating and socioeconomically challenging consequences.
AB - Background: Hypothyroidism is prevalent at all ages and represents a non-communicable disease with preventable consequences. Method: Narrative review. Review: In children and adolescents, the most devastating consequences of undertreatment with levothyroxine (LT4) are poor growth and development. Delayed treatment in congenital hypothyroidism can lead to permanent brain damage. In young to middle-aged adults, symptoms are often overlooked, and treatment delayed by many years. The resulting consequences are also at this age group compromised brain and physical function but less severe and partly reversible with treatment. The under-treated condition often results in a higher risk of, e.g., increased cardiovascular disease burden, obesity, hypertension, poor physical capacity, and poor quality of life. Excessive replacement is at all adult age groups associated with increased risk of cardiac death, osteoporosis, loss of muscle function, psychological instability and poor quality of life. In young fertile women, the consequences of undertreatment with LT4 are subnormal fertility, recurrent pregnancy loss, compromised fetal growth, and neurocognitive development. On the other hand, excessive LT4 treatment has been related to gestational hypertension, preeclampsia and preterm birth. In the elderly, care must be given to avoid confusing a slightly high age-related serum TSH with requirement for LT4 treatment in a truly hypothyroid patient. Excessive LT4 treatment in patients of high age is associated with an increased mortality. Conclusion: Suboptimal and excessive LT4 replacement of the preventable non-communicable disease hypothyroidism requires more focus from the healthcare system and from the global political systems to prevent the personally devastating and socioeconomically challenging consequences.
KW - Hypothyroidism
KW - Non-communicable disease
KW - Replacement
KW - Suboptimal treatment
U2 - 10.1007/s40618-023-02229-7
DO - 10.1007/s40618-023-02229-7
M3 - Review
C2 - 38015369
AN - SCOPUS:85177824159
VL - 47
SP - 1083
EP - 1090
JO - Journal of Endocrinological Investigation
JF - Journal of Endocrinological Investigation
SN - 0391-4097
IS - 5
ER -
ID: 387977789