Treatment refractory hypothyroidism


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hipotiroidismo refractario
hormona tiroidea Hypothiroidism

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Pantoja-Rosero, M. E., Lara-Viáfara, M. F., & Builes-Barrera, C. A. (2023). Treatment refractory hypothyroidism. Interdisciplinary Journal of Epidemiology and Public Health, 5(2), e–9905. (Original work published December 30, 2022)


Introduction: Refractory hypothyroidism is an entity in which patients require high doses of thyroid hormone, persisting with symptoms of hypothyroidism and high thyroid stimulating hormone (TSH) levels, representing a challenge for the clinician. Understanding its causes allows a better diagnostic approach and avoids overdosage and adverse effects. 

Objective: To present key concepts to help identify the causes of refractoriness to treatment, including adherence, malabsorption, or increased thyroid hormone demand. 

Methods: A search of the main concepts about the causes, diagnosis and treatment of refractory hypothyroidism was performed, according to the review presented at the congress of the Colombian Association of Internal Medicine (ACMI) on May 13 and 14, 2022.

Results: Persistent TSH elevation in patients receiving thyroid hormone supplementation may be present in up to 30% of patients with hypothyroidism. The most frequent cause is poor adherence to treatment, followed by malabsorption and increased demand for the drug. The diagnostic approach should be sequential to find the cause, in some performing specialized studies to rule out malabsorption.

Conclusions: Identifying the causes of refractory hypothyroidism to treatment are key to have an adequate symptomatic and clinical control of the pathology, and likewise avoid the use of supratherapeutic doses of levothyroxine, since it is related to major adverse effects at cardiovascular and bone level.
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