Hypothyroidism in Context: Where We’ve Been and Where We’re Going - 2019
Luca Chiovato, Flavia Magri, Allan Carlé
Hypothyroidism affects up to 5% of the general population, with a further estimated 5% being undiagnosed. Over 99% of affected patients suffer from primary hypothyroidism. Worldwide, environmental iodine deficiency is the most common cause of all thyroid disorders, including hypothyroidism, but in areas of iodine sufficiency, Hashimoto’s disease (chronic autoimmune thyroiditis) is the most common cause of thyroid failure. Hypothyroidism is diagnosed biochemically, being overt primary hypothyroidism defined as serum thyroid-stimulating hormone (TSH) concentrations above and thyroxine concentrations below the normal reference range. Symptoms of hypothyroidism are non-specific and include mild to moderate weight gain, fatigue, poor concentration, depression, and menstrual irregularities, while the consequences of untreated or under-treated hypothyroidism include cardiovascular disease and increased mortality. Levothyroxine has long been the main tool for treating hypothyroidism and is one of the world’s most widely prescribed medicines. In adults with overt hypothyroidism, levothyroxine is usually prescribed at a starting dose of 1.6 µg/kg/day, which is then titrated to achieve optimal TSH levels (0.4–4.0 mIU/L), according to the therapeutic target. We here summarise the history of levothyroxine and discuss future issues regarding the optimal treatment of hypothyroidism. Because nearly one-third of patients with treated hypothyroidism still exhibit symptoms, it is important that levothyroxine is used more appropriately to achieve maximum benefit for patients. In order to ensure this, further research should include more accurate assessments of the true prevalence of hypothyroidism in the community, optimisation of the levothyroxine substitution dose, proper duration of treatment, and identification of patients who may benefit from combination therapy with levothyroxine plus levotriiodothyronine. Funding: Merck. Plain Language Summary: Plain language summary available for this article.
Everolimus Plus Exemestane in Postmenopausal Patients with HR+ Breast Cancer: BOLERO-2 Final Progression-Free Survival Analysis Tập 30 Số 10 - Trang 870-884 - 2013
Denise A. Yardley, Shinzaburo Noguchi, Kathleen I. Pritchard, Howard A. Burris, José Baselga, Michael Gnant, Gabriel N. Hortobágyi, Mario Campone, Barbara Pistilli, Martine Piccart, Bohuslav Melichar, Katarína Petráková, Francis P. Arena, Frans Erdkamp, Wael A. Harb, Wentao Feng, Ayelet Cahana, Tetiana Taran, David Lebwohl, Hope S. Rugo
Pirfenidone in Idiopathic Pulmonary Fibrosis: Expert Panel Discussion on the Management of Drug-Related Adverse Events Tập 31 Số 4 - Trang 375-391 - 2014
Ulrich Costabel, Elisabeth Bendstrup, Vincent Cottin, Pieter Dewint, Jim Egan, J. Ferguson, Richard Groves, Per M. Hellström, Michael Kreuter, Toby M. Maher, María Molina-Molina, Klas Nordlind, Alexandre Sarafidis, Carlo Vancheri