ReviewJournal of endocrinological investigation2017
Diagnosis and management of treatment-refractory hypothyroidism: an expert consensus report.
Review in Journal of endocrinological investigation, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 58 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
58 citing papers in PubMed, 2 syntheses or guidelines pooled it, 106 citations in OpenAlex.
- ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism.European thyroid journal · 2025Guideline
- A Systematic Review and Meta-Analysis of Patient Preferences for Combination Thyroid Hormone Treatment for Hypothyroidism.Frontiers in endocrinology · 2019Pooled it
- Review
- Review
- From Resistance to Relief: IV Levothyroxine in Refractory Hypothyroidism Management.Clinical case reports · 2025Article
- Refractory Hypothyroidism: Unexpected Outcome During Treatment of Giant Cell Arteritis.Clinical case reports · 2025Article
- Levothyroxine absorption test in patients with refractory hypothyroidism: how to interpret patient's response to the test?Endocrine · 2025Article
- Pseudo-Malabsorption in High Dose Levothyroxine-Resistant Hypothyroidism.JCEM case reports · 2025Article
- Worsening of Congenital Hypothyroidism After Start of Carob-bean Gum Thickened Formula: Is There a Link? A Case ReportJournal of clinical research in pediatric endocrinology · 2025Article
- Thyroxine overuse and clinical indices guiding successful treatment withdrawal.Journal of endocrinological investigation · 2025Article
- Article
- Intramuscular and subcutaneous levothyroxine: success in treating refractory hypothyroidism.European thyroid journal · 2025Article
- Levothyroxine Absorption Test With the Daily Levothyroxine Dose in Patients With "Refractory Hypothyroidism".Journal of the Endocrine Society · 2025Article
- Levothyroxine malabsorption following sleeve gastrectomy.Endocrinology, diabetes & metabolism case reports · 2025Article
- Gut microbiota in hypothyroidism: pathogenic mechanisms and opportunities for precision microbiome interventions.Frontiers in microbiology · 2025Review
- Rapid supervised levothyroxine absorption test in refractory hypothyroidism: suggestion for assessing absorption using two blood samples in low-resource settings.Endocrine connections · 2024Article
- Medication-Nonadherent Hypothyroidism Requiring Frequent Primary Care Visits to Achieve Euthyroidism.Federal practitioner : for the health care professionals of the VA, DoD, and PHS · 2024Article
- Liquid L-T4 therapy in hypothyroid patients with gastric diseases, an observational study.Frontiers in endocrinology · 2024Observational
- Analysis of dose-TSH response effect of levothyroxine soft-gel formulation.Frontiers in endocrinology · 2024Article
- The association between primary frozen shoulder and serum lipids may be overestimated: evidence based on retrospective observational studies and Mendelian randomization.Frontiers in endocrinology · 2024Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
There is a frequently encountered subset of hypothyroid patients who are refractory to standard thyroid hormone replacement treatment and require unexpectedly high doses of levothyroxine. In addition to clinical situations where hypothyroid patients are non-compliant, or where there is the possibility of excipient-induced disease exacerbation (gluten/celiac disease), therapeutic failure may be due to impaired absorption of the administered drug. The common approach to managing patients with unusual thyroxine needs is to escalate the dose of levothyroxine until targeted TSH levels are achieved. This approach can increase the risk for prolonged exposure to supratherapeutic doses of levothyroxine, which increase the chances of adverse outcomes. Repeated adjustments of levothyroxine can also escalate the costs of treatment, as frequent office visits and laboratory tests are required to determine and maintain the desired dose. Clinicians should take a systematic approach to managing patients whom they suspect of having treatment-refractory hypothyroidism. This may include searching for, and adjusting, occult medical conditions and/or other factors that may affect the absorption of levothyroxine, before up-titrating the dose of traditional levothyroxine therapy. Depending on the underlying pathology, another approach that may be considered is to try alternative formulations of levothyroxine that are less susceptible to intolerance issues related to excipients, or, in some cases, to malabsorption. The early discovery of these factors via a thoughtful patient work-up may avoid unnecessary thyroid medication adjustments and their consequences for both patients and clinicians.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.