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Too little thyroid hormone. Symptoms include weight gain, constipation, dry skin, and sensitivity to the cold. Also called underactive thyroid.

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Thyroid hormone replacement for subclinical hypothyroidism

Subclinical hypothyroidism is a condition where some laboratory findings point at a thyroid gland not working properly. Patients with subclinical hypothyroidism may have vague, non‐specific symptoms of actual hypothyroidism (for example dry skin, cold skin or feeling colder, constipation, slower thinking, poor memory) but these thyroid‐related symptoms are not specific, that is why the diagnosis is based on test results. The fundamental question regarding people with subclinical hypothyroidism is whether they should be treated with thyroid hormones. To answer this question twelve studies of six to 14 months duration involving 350 people were analysed. Thyroid hormone therapy for subclinical hypothyroidism did not result in improved survival or decreased cardiovascular morbidity (for example less heart attacks or strokes). Data on health‐related quality of life and symptoms did not demonstrate significant differences between placebo and thyroid hormone therapy. Some evidence indicated that thyroid hormone had some effects on blood lipids and technical measurements of heart function. Adverse effects were inadequately addressed in most of the included studies and have to be urgently investigated in future studies, especially in older patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

High versus low dose of initial thyroid hormone replacement for congenital hypothyroidism

Congenital hypothyroidism is a condition that affects infants from birth and results from a missing or abnormally developed thyroid gland, abnormal production of thyroid hormones or a failure of the pituitary gland to stimulate thyroid hormone production. It affects approximately 1 in 3000 to 4000 newborn infants and early diagnosis and treatment is very important to achieve a good outcome.Treatment of congenital hypothyroidism consists of a daily dose of thyroid hormone (thyroxine). However, the initial dose of thyroxine required to improve outcomes for infants with this condition is unclear and has been the subject of several studies. Some studies have suggested that when infants with congenital hypothyroidism are treated with a higher dose of thyroxine compared with the standard dose, this results in earlier normalisation of the their thyroid hormones and leads to better developmental outcome and intelligence.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Underactive thyroid: Deciding whether to treat subclinical hypothyroidism

Subclinical (latent) hypothyroidism means that the thyroid gland is still producing enough thyroid hormones. But some blood values may suggest the early stages of a hormone deficiency. Experts do not agree on whether subclinical hypothyroidism should be treated. It is not clear in which cases treatment would have advantages.If you already have noticeable (“overt” or “manifest”) hypothyroidism, the thyroid is no longer producing enough thyroid hormones. Thyroxine is the most important of the thyroid hormones. It helps regulate many of the body’s functions to balance your metabolism. Too little thyroxine can cause a number of different health problems. The symptoms range from cold hands to physical weakness, slower mental processes and depression. An underactive thyroid (hypothyroidism) is treated with hormone tablets that are taken once daily. These tablets act to replace the thyroxine that is not being produced. This can usually make the symptoms disappear completely.Subclinical hypothyroidism goes unnoticed. Only the body’s levels of TSH (“thyroid-stimulating hormone”) are too high. The thyroid is still producing enough thyroid hormones. The hormone TSH is produced in the pituitary gland and acts as a trigger for the thyroid to start producing the thyroid hormones. TSH levels that are just a little too high may be the first sign of the early stages of hypothyroidism: The pituitary gland responds to lower levels of thyroid hormones by increasing TSH production to activate the thyroid. It is also possible that TSH reaches higher levels only temporarily, for example after intense physical activity.It is estimated that about 5 out of 100 people have subclinical hypothyroidism. Slightly elevated TSH levels are usually detected by accident during a routine examination. But taken on their own they do not pose any health risk – often the effect is just temporary. Experts do not fully agree on how to decide in which cases subclinical hypothyroidism should be treated.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: October 8, 2014

Chinese herbal medicines for hypothyroidism

Hypothyroidism, also known as underactive or low thyroid, is a condition in which the thyroid gland does not produce sufficient amounts of thyroid hormones which are important for many functions of the body (metabolism). In adults hypothyroidism may cause fatigue and sluggishness, increased sensitivity to cold, constipation, pale and dry skin, brittle fingernails and hair, a puffy face, hoarse voice, unexplained weight gain, muscle aches, tenderness, stiffness and weakness, pain, stiffness or swelling in the joints, heavier than normal menstrual periods, and depression. Hypothyroidism in infants and teenagers may result in poor growth and mental development as well as delayed development of permanent teeth and puberty.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Screening and Treatment of Subclinical Hypothyroidism or Hyperthyroidism [Internet]

This report focused on four questions:

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: October 2011
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Hypothyroidism (primary)

INTRODUCTION: Hypothyroidism is six times more common in women, affecting up to 40 in 10,000 each year (compared with 6/10,000 men).

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

[Should depressive symptoms in patients with subclinical hypothyroidism be treated with thyroid hormone?]

BACKGROUND: Although there are theoretical grounds for using hormone therapy to treat depressive symptoms in patients with hypothyroidism, the clinical evidence for this is unclear. objective To investigate the efficacy of treating depression with thyroid hormone in a population with subclinical hypothyroidism.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Radiation-induced hypothyroidism in head and neck cancer patients: a systematic review

PURPOSE: To review literature on the relationship between the dose distribution in the thyroid gland and the incidence of radiation-induced hypothyroidism in adults.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Iodine supplementation for preventing iodine deficiency disorders in children

Iodine deficiency causes mental retardation in children as well as an enlarged thyroid gland (goitre) and sometimes deficiencies in thyroid hormones in people of all ages. It still exists in large parts of the world. This review looked at studies with a comparison group of iodine supplementation in children. Twenty‐six studies were included, but these were generally of poor quality. Iodine was given as iodised oil, salt or water. Giving iodine generally decreased thyroid size and increased iodine in the urine. One study suggested a reduction in infant mortality. In some studies there was a trend towards better developmental outcomes after iodine prophylaxis. There was some concern in studies using iodised salt that small children may not eat enough salt to achieve adequate iodine status. Adverse effects were reported, and most of them were minor and did not last long. More high quality long term studies measuring outcomes related to child development, to deaths associated with iodine‐deficiency, and to intervention programmes relevant to children in developed countries, are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Recombinant human thyrotropin (rhTSH) aided radioiodine treatment for residual or metastatic differentiated thyroid cancer

After the removal of the thyroid gland (thyroidectomy) thyroid hormones have to be substituted to attain a normal way of life. Thyroid hormone withdrawal for four to six weeks has been used for more than 50 years for the treatment of metastatic differentiated thyroid cancer after thyroidectomy because residual cancer cells may then be better destroyed by radiation therapy using radioiodine. Another therapeutic approach to prepare for radiation uses injections of technologically created (recombinant) human thyroid‐stimulating hormone (thyrotropin, TSH) to avoid the symptoms of a malfunctioning thyroid gland (hypothyroidism), which are caused by thyroid hormone withdrawal. This technique has been approved for use in the diagnosis of recurrent and metastatic differentiated thyroid cancer and in the preparation of patients for elimination of normal thyroid remnants after thyroid surgery, but not for treatment of known locally recurrent or metastatic disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Interventions to reduce harm to women and their children from untreated low levels of thyroid hormone in pregnancy

The thyroid is a butterfly‐shaped gland at the front of the oesophagus/throat that produces thyroid hormone. Thyroid hormone helps the body to make energy, keeps body temperature regulated and assists other organs in their functions. Hypothyroidism (a deficiency of thyroid hormone) is a relatively common illness that can cause fatigue, constipation, muscle cramps and weakness, hair loss, dry skin, intolerance to cold, depression and weight gain. Medication is with levothyroxine. Selenium is a trace element that changes the expression of selenoproteins. These act as antioxidants and appear to decrease thyroid inflammation in autoimmune thyroiditis. Pregnant women with subclinical hypothyroidism have abnormal thyroid hormone levels but no symptoms. They are at a increased risk of miscarriage, pre‐eclampsia and preterm birth with impaired neuropsychological development in the child.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Risk of hypothyroidism in patients with cancer treated with sunitinib: a systematic review and meta-analysis

BACKGROUND: The multitargeted tyrosine kinase inhibitor sunitinib is used in various cancers. Clinical studies have reported a substantial variation in the incidence of hypothyroidism associated with sunitinib, without a systemic attempt to synthesize these data.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Levothyroxine treatment and pregnancy outcome in women with subclinical hypothyroidism undergoing assisted reproduction technologies: systematic review and meta-analysis of RCTs

BACKGROUND Previous meta-analyses of observational data indicate that pregnant women with subclinical hypothyroidism have an increased risk of adverse pregnancy outcome. Potential benefits of levothyroxine (LT4) supplementation remain unclear, and no systematic review or meta-analysis of trial findings is available in a setting of assisted reproduction technologies (ART). METHODS Relevant trials published until August 2012 were identified by searching MEDLINE, EMBASE, Web of Knowledge, the Cochrane Controlled Trials Register databases and bibliographies of retrieved publications without language restrictions. RESULTS From 630 articles retrieved, we included three trials with data on 220 patients. One of these three trials stated 'live delivery' as outcome. LT4 treatment resulted in a significantly higher delivery rate, with a pooled relative risk (RR) of 2.76 (95% confidence limits 1.20-6.44; P = 0.018; I(2) = 70%), a pooled absolute risk difference (ARD) of 36.3% (3.5-69.0%: P = 0.030) and a summary number needed to treat (NNT) of 3 (1-28) in favour of LT4 supplementation. LT4 treatment significantly lowered miscarriage rate with a pooled RR of 0.45 (0.24-0.82; P = 0.010; I(2) = 26%), a pooled ARD of -31.3% (-48.2 to -14.5%: P < 0.001) and a summary NNT of 3 (2-7) in favour of LT4 supplementation. LT4 treatment had no effect on clinical pregnancy (RR 1.75; 0.90-3.38; P = 0.098; I(2) = 82%). In an ART setting, no data are available on the effects of LT4 supplementation on premature delivery, arterial hypertension, placental abruption or pre-eclampsia. CONCLUSIONS Our meta-analyses provide evidence that LT4 supplementation should be recommended to improve clinical pregnancy outcome in women with subclinical hypothyroidism and/or thyroid autoimmunity undergoing ART. Further research is needed to determine pregnancy outcome after close monitoring of thyroid function to maintain thyroid-stimulating hormone and free T4 levels within the trimester-specific reference ranges for pregnancy.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Alteration of lipid profile in subclinical hypothyroidism: a meta-analysis

BACKGROUND: Previous studies yielded controversial results about the alteration of lipid profiles in patients with subclinical hypothyroidism. We performed a meta-analysis to investigate the association between subclinical hypothyroidism and lipid profiles.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Evaluation of left ventricular diastolic function using tissue Doppler echocardiography and conventional doppler echocardiography in patients with subclinical hypothyroidism aged <60 years: a meta-analysis

Studies have suggested that subclinical hypothyroidism (SCH) may have detrimental effects on left ventricular (LV) diastolic function. Whether SCH is a risk factor for LV diastolic dysfunction is controversial. Databases (MEDLINE, PubMed, EMBASE) were searched for cross-sectional studies evaluating LV diastolic function in SCH patients aged <60 years using tissue Doppler echocardiography (TDE) and conventional two-dimensional Doppler echocardiography (2D-DECG) published in the past 12 years. The weighted mean difference (WMD) and 95% confidence interval (CI) were calculated using fixed or random-effects models. We summarized the results of 14 cross-sectional studies with 675 participants. SCH patients had a significantly lower LV mitral annular E(a) peak velocity (WMD=-1.71 cm/s; 95%CI: -3.02 to -0.40; p<0.05), E(a)/A(a) ratio (WMD=-0.22; 95%CI: -0.40 to -0.05; p<0.05), and significantly higher mitral annular A(a) peak velocity (WMD=0.47 cm/s; 95%CI: 0.10-0.85; p<0.05) than euthyroid subjects using TDE. Subgroup analyses showed that statistical significance existed only in E(a) and E(a)/A(a) parameters when data from "women ≥ 90%" were used, and in the A(a) parameter when data from "women<90%" were used. No matter which subgroup of females was used, there were significant differences in LV peak transmitral A velocity (WMD=7.64 cm/s; 95%CI: 4.55-10.73; p<0.05), and E/A ratio (WMD=-0.22; 95%CI: -0.31 to -0.21; p<0.05) but no significant difference in peak transmitral E velocity (p>0.05) between SCH patients and euthyroid controls using 2D-DECG. Therefore, for those aged <60 years, SCH patients had significantly worse parameters of LV diastolic function than euthyroid controls.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Subclinical hypothyroidism and the risk of coronary heart diesase and mortality

CONTEXT: Data regarding the association between subclinical hypothyroidism and cardiovascular disease outcomes are conflicting among large prospective cohort studies. This might reflect differences in participants' age, sex, thyroid-stimulating hormone (TSH) levels, or preexisting cardiovascular disease.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Thyroxine alone or thyroxine plus triiodothyronine replacement therapy for hypothyroidism

The review concluded that thyroxine plus triiodothyronine replacement therapy did not improve well-being, cognitive function, or quality of life compared with thyroxine alone (which may be beneficial in improving psychological or physical well-being). The review's sometimes poor or inconsistent reporting, coupled with the questionable quality of several included trials, indicate that the authors' conclusions should be interpreted with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Risk of hypothyroidism following hemithyroidectomy: systematic review and meta-analysis of prognostic studies

This generally well-conducted review concluded that about 20% of patients develop low thyroid levels after removing half the thyroid gland; one in 25 have free thyroxine and thyroid stimulating hormone levels below normal. Uncertainty over the quality of the included studies and the diversity and limitations of the available evidence make the reliability of the conclusions uncertain.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Research studies: What are the advantages and disadvantages of combined treatment with antithyroid drugs and radioiodine?

Using antithyroid drugs before, during or after radioiodine therapy reduces the side effects of the treatment, but the trade-off is a similar reduction in treatment effectiveness.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: October 9, 2014

Underactive thyroid: Overview

If you suddenly start feeling tired and listless all the time and notice a slow pulse and constipation, you may wonder what the cause might be. These kinds of symptoms can have any number of causes, but they are typical of an underactive thyroid (hypothyroidism). A blood test can tell you for sure whether you have it.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: October 8, 2014

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