MANAGEMENT OF ENDOCRINE DISEASE: Pitfalls on the replacement therapy for primary and central hypothyroidism in adults

European Journal of Endocrinology
Gisah Amaral de CarvalhoH Graf

Abstract

Hypothyroidism is one of the most common hormone deficiencies in adults. Most of the cases, particularly those of overt hypothyroidism, are easily diagnosed and managed, with excellent outcomes if treated adequately. However, minor alterations of thyroid function determine nonspecific manifestations. Primary hypothyroidism due to chronic autoimmune thyroiditis is largely the most common cause of thyroid hormone deficiency. Central hypothyroidism is a rare and heterogeneous disorder characterized by decreased thyroid hormone secretion by an otherwise normal thyroid gland, due to lack of TSH. The standard treatment of primary and central hypothyroidism is hormone replacement therapy with levothyroxine sodium (LT4). Treatment guidelines of hypothyroidism recommend monotherapy with LT4 due to its efficacy, long-term experience, favorable side effect profile, ease of administration, good intestinal absorption, long serum half-life and low cost. Despite being easily treatable with a daily dose of LT4, many patients remain hypothyroid due to malabsorption syndromes, autoimmune gastritis, pancreatic and liver disorders, drug interactions, polymorphisms in DIO2 (iodothyronine deiodinase 2), high fiber diet, and more frequently, non-comp...Continue Reading

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Citations

Apr 14, 2020·JAAPA : Official Journal of the American Academy of Physician Assistants·Chelsea SimonSarah Allen
Oct 3, 2020·Thyroid : Official Journal of the American Thyroid Association·Endre V NagyLaszlo Hegedüs
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Jan 5, 2021·Frontiers in Neuroscience·Hui WangAi-Min Wu
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Mar 13, 2021·Frontiers in Endocrinology·Poupak FallahiAlessandro Antonelli
Apr 2, 2021·Frontiers in Endocrinology·Alessandro AntonelliPoupak Fallahi

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