Hypothyroidism

Effect of long-term exercise-based interventions on thyroid function in hypothyroidism: A systematic review and meta-analysis of randomized controlled trials.

Sundus H, Khan SA, Zaidi S, Chhabra C, Ahmad I, Khan H · Complementary therapies in medicine · 2025

This study aimed to assess the effects of exercise interventions of more than 8 weeks on thyroid function in adults with hypothyroidism through a systematic review and meta-analysis of randomized controlled trials. The PEDro, WOS, PubMed, Cochrane Central Register of Controlled Trials, and Scopus databases were searched for relevant articles, which then underwent standardised screening, data extraction, and bias risk assessment. A total of seven randomised controlled trials (n = 7) were included, predominantly examining 12 weeks of exercise therapy. A meta-analysis was conducted using data extracted from the included studies. Standardised mean differences were calculated for thyroid-stimulating hormone levels, and heterogeneity was assessed using the I2 statistic. The certainty of evidence was evaluated using the GRADE approach. Statistically significant reductions in thyroid stimulating hormone (TSH) levels (SMD: -3.254; 95 % CI: -3.937 to -2.572; p <&

Treatment Preferences in Patients With Hypothyroidism.

de Lima Beltrão FE, Carvalhal G, de Almeida Beltrão DC, de Lima Beltrão FE, Ribeiro MO, Ettleson MD · The Journal of clinical endocrinology and metabolism · 2025 · n=1135

Levothyroxine (L-T4) monotherapy is the standard of care for the treatment of hypothyroidism. A minority of L-T4-treated patients remain symptomatic and report better outcomes with combination therapy that contains liothyronine (L-T3) or with desiccated thyroid extract (DTE). This work aimed to assess patient preferences in the treatment of hypothyroidism. A systematic review, meta-analysis, meta-regression, and network meta-analysis of randomized controlled trials (RCTs) comparing treatments for adults with hypothyroidism (L-T4 vs L-T4 + L-T3 or DTE). Searches were conducted in PubMed, Embase, and Cochrane databases up to April 10, 2024. Data extraction and quality assessment were independently performed by 4 researchers. Eleven RCTs (8 cross-over studies) with a total of 1135 patients were considered. Overall, 24% of patients preferred L-T4 vs 52% who preferred L-T4 + L-T3 or DTE; 24% had no preference. The meta-analysis confirmed the preference for combination therapy over L-T4 m

Association between primary hypothyroidism and metabolic dysfunction-associated steatotic liver disease: an updated meta-analysis.

Mantovani A, Csermely A, Bilson J, Borella N, Enrico S, Pecoraro B · Gut · 2024 · n=24

Epidemiological studies have reported an association between primary hypothyroidism and metabolic dysfunction-associated steatotic liver disease (MASLD). However, the magnitude of the risk and whether this risk changes with the severity of MASLD remains uncertain. We performed a meta-analysis of observational studies to quantify the magnitude of the association between primary hypothyroidism and the risk of MASLD. We systematically searched PubMed, Scopus and Web of Science from database inception to 31 January 2024, using predefined keywords to identify observational studies in which MASLD was diagnosed by liver biopsy, imaging or International Classification of Diseases codes. A meta-analysis was performed using random-effects modelling. We identified 24 cross-sectional and 4 longitudinal studies with aggregate data on ~76.5 million individuals. Primary hypothyroidism (defined as levothyroxine replacement treatment, subclinical hypothyroidism or overt hypothyroidism) was ass

Iron and ferritin deficiency in women with hypothyroidism and chronic lymphocytic thyroiditis - systematic review.

Gierach M, Rudewicz M, Junik R · Endokrynologia Polska · 2024

Iron is one of the essential microelements necessary for maintaining the body's homeostasis. It serves various roles, including being a crucial component in the proper structure of many enzymes and supporting the transport of oxygen and electrons. Its deficiency can lead to anaemia, which is a common clinical condition often associated with thyroid diseases. Iron deficiency is one of the most common nutritional deficiencies, and its prevalence is strongly associated with socioeconomic status. It is the primary cause of anaemia in 42% of children and 50% of women. Importantly, iron deficiency is placed among the top 5 causes of disability in women. Thyroid peroxidase (TPO) is an enzyme essential for the production of thyroid hormones, and iron is a key factor in its proper functioning. Therefore, in the case of iron deficiency, the activity of this enzyme is also reduced. Iron is also a factor that is important in epigenetic modification processes, and its deficiency may contribute to g

The relationship between thyroid and human-associated microbiota: A systematic review of reviews.

Virili C, Stramazzo I, Bagaglini MF, Carretti AL, Capriello S, Romanelli F · Reviews in endocrine & metabolic disorders · 2024

In recent years, a growing number of studies have examined the relationship between thyroid pathophysiology and intestinal microbiota composition. The reciprocal influence between these two entities has been proven so extensive that some authors coined the term "gut-thyroid axis". However, since some papers reported conflicting results, several aspects of this correlation need to be clarified. This systematic review was conceived to achieve more robust information about: 1)the characteristics of gut microbiota composition in patients with the more common morphological, functional and autoimmune disorders of the thyroid; 2)the influence of gut microbial composition on micronutrients that are essential for the maintenance of thyroid homeostasis; 3)the effect of probiotics, prebiotics and synbiotics, some of the most popular over-the-counter products, on thyroid balance; 4)the opportunity to use specific dietary advice. The literature evaluation was made by three authors independently. A

Effects of yoga on hypothyroidism: A systematic review.

Baishya A, Metri K · Journal of Ayurveda and integrative medicine · 2024

Evidence from clinical trials has shown positive effects of yoga on hypothyroidism. To date, there is no review of these studies. This systematic review evaluates the efficacy of yoga as a therapeutic intervention for hypothyroidism. PubMed, Medline, PsycINFO, and Science Direct databases were searched to identify relevant literature. The review included clinical studies that evaluated the effects of yoga on hypothyroidism. Studies that were not conducted inenglish, unavailable, non-experimental, or those that were reviews, case studies, case reports, not based on yoga, involved yoga as a intervention, or included a mixed population were excluded. Eleven studies (n = 516) met the eligibility criteria. Of these, four studies were RCTs, two non-RCTs and five were pretest-posttest studies. The duration of the yoga intervention varied from 1 to 6 months. Most of these studies adopted a combination of suryanamaskar, asana, pranayama and meditation. On quality assessment, one study

ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism.

Centanni M, Duntas L, Feldt-Rasmussen U, Koehrle J, Peeters RP, Razvi S · European thyroid journal · 2025

Sodium levothyroxine (LT4) as a monotherapy represents the mainstay of treatment of hypothyroidism, and its use has increased over time. Nevertheless, it faces several potential barriers in its 'real life' utilization, and hence its clinical effectiveness may be marred. This is suggested by the frequent situation of patients failing to reach the therapeutic goals of symptom relief and serum TSH control. Thus, an expert task force was approved by the Guidelines Board of the European Thyroid Association to examine the available data and to formulate recommendations based on the available evidence and the experts' deduction. The task force provides a body of suggestions to optimize the levothyroxine treatment in monotherapy, considering the key point in the individualization of treatment. Furthermore, the nutritional, pharmacological and pathological factors, potentially leading to the increased need for levothyroxine, are discussed, with a specific focus on the use of liquid and softgel

International Consensus Guideline on the Diagnosis and Management of Endocrine Complications of β and α Thalassemia in Children and Adolescents.

Habeb A, Deeb A, Hamza RT, Iughetti L, Jalaludin MY, Muze KC · Hormone research in paediatrics · 2025

β thalassemia (βT) and α thalassemia (αT) are chronic hemolytic anemias caused by hereditary defects in the β or α chains of hemoglobin, respectively. According to the clinical picture, both forms of thalassemia are subdivided into minor, intermedia, or major. Previous guidelines focused on growth and endocrine dysfunctions in βT major, where the complications reported are consequences of iron toxicity. However emerging evidence shows that patients with other forms of thalassemia are also at risk of some endocrinopathies. This guideline provides consensus on the screening and management of endocrine complications of children and adolescents with different forms of thalassemia. The panel has 14 experts from 13 countries representing 8 societies. They reviewed literature up to 2024 for the highest available evidence on the subject and 42 recommendations were modified until at least 70% vote for agreement was achieved. Hypogonadism, delayed growth

[Clinical guideline of «congenital hypothyroidism»].

Peterkova VA, Bezlepkina OB, Shiryaeva TU, Vadina TA, Nagaeva EV, Chikulaeva OA · Problemy endokrinologii · 2022

Congenital hypothyroidism is an important issue of pediatric endocrinology at which timely diagnosis and treatment can prevent the development of severe cases of the disease. The developed clinical guidelines are a working tool for a practicing physician. The target audience is pediatric endocrinologists and pediatricians. They briefly and logically set out the main definition of the disease, epidemiology, classification, methods of diagnosis and treatment, based on the principles of -evidence-based medicine. Врожденный гипотиреоз является актуальной проблемой детской эндокринологии,

Fasting vs Nonfasting, Dose-adjusted Levothyroxine Ingestion in Hypothyroidism: A Randomized Clinical Trial.

Willems JIA, van Twist DJL, Helmich F, Sluiter T, Medici M, Peeters RP · The Journal of clinical endocrinology and metabolism · 2026 · n=43

Levothyroxine (LT4) is recommended for intake in a fasting state to optimize absorption. However, fasting intake is often burdensome and may reduce adherence. In a previous questionnaire study, we observed a strong patient preference for taking LT4 with breakfast. Therefore, we conducted a randomized controlled trial to evaluate whether nonfasting LT4 intake-accompanied by a 15% dose increase-could maintain TSH stability compared to fasting LT4 intake. Adults with well-controlled hypothyroidism were randomized to fasting or dose-adjusted, breakfast LT4 intake. TSH, free T4, and total T3 were measured every 6 weeks, followed by LT4 dose adjustment if needed. The primary outcome was TSH stability, defined as 2 consecutive values within the reference range and a maximum ±1 mIU/L change from baseline. Patients were followed until TSH stability was reached, with a maximum of 24 weeks. After the initial study period, patients in the fasting group were invited to cross over to no

Randomized Study of the Effects of Zinc, Vitamin A, and Magnesium Co-supplementation on Thyroid Function, Oxidative Stress, and hs-CRP in Patients with Hypothyroidism.

Rabbani E, Golgiri F, Janani L, Moradi N, Fallah S, Abiri B · Biological trace element research · 2021

Hypothyroidism can occur due to deficiencies in micronutrients such as zinc, magnesium, and vitamin A. The aim of this study was to determine the effects of supplementation with these micronutrients on thyroid function, oxidative stress, and hs-CRP levels in patients with hypothyroidism. In a randomized double-blind, placebo-controlled trial with two parallel groups, 86 hypothyroid patients aged 20-65 were allocated to receive daily supplementation with either: (intervention group, n = 43) one 30 mg zinc gluconate capsule per day, one 250 mg magnesium oxide tablet per day, and one 25,000 IU vitamin A capsule twice/week for 10 weeks or (placebo group, n = 43) placebo capsules and tablets as above for 10 weeks. Neither of the groups changed their diet or physical activity. Thyroid hormones (free and total thyroxine (FT4 and TT4), free tri-iodothyronine (FT3), and thyroid-stimulating hormone (TSH)), oxidative markers (malondialdehyde (M

Effects of Aloe barbadensis Miller juice on Hashimoto's thyroiditis-related subclinical hypothyroidism

Metro D, Cernaro V, Santoro D, Papa M, Buemi M, Benvenga S · Endocrine, Metabolic & Immune Disorders - Drug Targets · 2018 · n=30

TSH normalized and TPO antibodies decreased significantly in the majority of subjects; free T4 rose into normal range.

Neuro-immune, metabolic, and oxidative pathways in depression due to hypothyroidism and Hashimoto's thyroiditis.

Al-Baldawi SQ, Al-Hakeim HK, Khémiri I, Maes M · Journal of affective disorders · 2026

Hypothyroidism is linked to depression and several metabolic alterations, including insulin resistance, dyslipidemia, and oxidative stress. This study investigates the impact of hormones, autoimmunity, metabolic, and antioxidant indicators on the severity of depression in patients with hypothyroidism. Forty-six patients with hypothyroidism and seventy-four with Hashimoto's thyroiditis participated in this study, along with sixty healthy controls. Patients were categorized based on the Hamilton Depression Rating Scale (≥ 17) into those with depression and those without. The enzyme-linked immunosorbent assay method was employed to evaluate blood insulin and selenoprotein P (SePP). Graphite furnace atomic absorption spectrophotometry was employed to quantify serum selenium concentrations. Serum zinc and lipid profile indicators were measured using spectrophotometry. Hypothyroidism and Hashimoto's thyroiditis are linked to increased atherogenicity, insulin resistance, and reduced

Association of gestational thyroid function and thyroid autoimmunity with gestational diabetes: a systematic review and individual participant meta-analysis.

Osinga JAJ, Derakhshan A, Karachaliou M, Poppe KG, Warringa L, Verdonk K · The lancet. Diabetes & endocrinology · 2025 · n=548

Pregnancy is a state of increased metabolic demand that necessitates major changes in endocrine physiology. Gestational thyroid dysfunction and gestational diabetes are common endocrine conditions of pregnancy that frequently coincide. Although the effects of thyroid hormones on glucose metabolism are well documented, important knowledge gaps remain in terms of the extent and clinical relevance of these effects during pregnancy. The aim of this meta-analysis is to assess the association of thyroid function test results with gestational diabetes and markers of glucose metabolism. In this systematic review and individual participant data meta-analysis, we searched Ovid MEDLINE, EMBASE, and Web of Science from database inception to Dec 12, 2024, for prospective population-based cohort studies with individual patient data on thyroid function, gestational diabetes, and measures of glucose homoeostasis during pregnancy. Furthermore, open invitations to join the Consortium on Thyroid and Pre

Risk Factors for Thyroid Dysfunction in Pregnancy: An Individual Participant Data Meta-Analysis.

Osinga JAJ, Liu Y, Männistö T, Vafeiadi M, Tao FB, Vaidya B · Thyroid : official journal of the American Thyroid Association · 2024 · n=559

Background: International guidelines recommend targeted screening to identify gestational thyroid dysfunction. However, currently used risk factors have questionable discriminative ability. We quantified the risk for thyroid function test abnormalities for a subset of risk factors currently used in international guidelines. Methods: We included prospective cohort studies with data on gestational maternal thyroid function and potential risk factors (maternal age, body mass index [BMI], parity, smoking status, pregnancy through in vitro fertilization, twin pregnancy, gestational age, maternal education, and thyroid peroxidase antibody [TPOAb] or thyroglobulin antibody [TgAb] positivity). Exclusion criteria were pre-existing thyroid disease and use of thyroid interfering medication. We analyzed individual participant data using mixed-effects regression models. Primary outcomes were overt and subclinical hypothyroidism and a treatment indication (defined as overt hypothyroidism, subclinica

Risk of hypothyroidism in meat-eaters, fish-eaters, and vegetarians: a population-based prospective study.

Candussi CJ, Bell W, Thompson AS, Knüppel S, Gaggl M, Světnička M · BMC medicine · 2025 · n=831

Plant-based diets are gaining popularity due to their well-documented cardiometabolic benefits and environmental sustainability. However, these diets are often lower in specific micronutrients such as iodine, raising concerns about their potential impact on thyroid health. Therefore, we examined the associations between plant-based diets and the risk of hypothyroidism. We analysed data from the UK (United Kingdom) Biobank cohort. Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incident hypothyroidism across vegans, vegetarians, pescatarians, poultry-eaters, low meat-eaters, and high meat-eaters aged 40-69 years. Ancillary to this, we carried out logistic regression analyses to evaluate associations between the diet groups and prevalent hypothyroidism according to International Classification of Diseases (ICD) codes at baseline. We included 466,362 individuals from the UK Biobank, of which 22

Hypothyroidism (Underactive Thyroid)

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

This page from NIDDK, part of the NIH, offers detailed information on hypothyroidism, including causes, symptoms, diagnosis, and treatment. It serves as a reliable educational resource for both patients and healthcare professionals.

Hypothyroidism

Endocrine Society

The Endocrine Society offers patient-focused information on hypothyroidism, explaining the condition, its symptoms, and treatment approaches. It acts as an educational resource for individuals with the condition.

Neurocognitive and Metabolic Effects of Mild Hypothyroidism

n=173 · NCT00565864 · COMPLETED · COMPLETED

Patients with hypothyroidism are routinely treated with thyroid hormone (l-thyroxine) for replacement therapy. Physicians monitor the thyroid hormone dose by measuring a thyroid stimulating hormone (TSH) level in the blood, with the goal of a normal level. However, recent data suggest that the "normal" TSH range is too broad, and that patients may still have symptoms if their TSH levels are at the top or bottom part of the normal range. To study this issue, it is useful to address issues such as general health status, psychological symptoms, mood, memory, and metabolic status, since thyroid hormone has major effects on the brain and metabolism, and since patients with treated hypothyroidism often have symptoms related to these areas. In the present study, otherwise healthy subjects with treated hypothyroidism, ages 20-75 years, will be enrolled in a 7-11month study. At baseline, they will have tests of health status, psychological symptoms, mood, memory, body composition, and energy expenditure performed. Following these baseline measurements, subjects will receive either their usual doses of l-thyroxine, or a slightly higher or lower dose. The doses will be chosen to try to achieve either a low-normal TSH level, a high-normal TSH level, or a mildly elevated TSH level. Which target TSH the patient is assigned will be determined randomly, and neither the subject nor the study contacts will know which dose the patient is receiving. Subjects will be seen every 6 weeks during the study for brief visits to make sure they are not having any side effects, and to adjust the l-thyroxine doses if the TSH has not yet reached the target range. At the 24-week visit (end of study), the subjects will undergo the same tests that they had on the baseline visit. Results from the study will be examined to see if minor changes in TSH or other thyroid hormone levels cause changes in any of the outcomes, and if the degree of TSH change correlates with the degree of outcome changes. These results may help physicians caring for patients with thyroid disease better determine the optimal dose of thyroid hormone for each patient.

A Single-center Interventional Study to Verify Clinical Utility of the Quantitative and the Qualitative POC TSH Test Kits Compared With the Third Generation TSH Test Kit

n=283 · NCT01921452 · COMPLETED · COMPLETED

This is a Phase 4, single-center, open-label, interventional study, wherein all enrolled subjects will be tested for Thyroid Stimulating Hormone (TSH) by using the quantitative and the qualitative Point-of-Care (POC) TSH test kits and the third generation TSH test kit at the same time.

Letrozole Alone vs. Letrozole Plus Levothyroxine for Ovulation Induction in Infertile Women With Both (Polycystic Ovary Syndrome) PCOS and Sub-clinical Hypothyroidism.

n=200 · NCT06041204 · RECRUITING · RECRUITING

The goal of this randomized controlled trial is to compare letrozole alone versus letrozole plus levothyroxine for ovulation induction in infertile women with both PCOS and subclinical hypothyroidism. The main questions it aims to answer are: Is letrozole plus levothyroxine superior to letrozole alone in achieving ovulation in these patients? Does combining levothyroxine with letrozole lead to higher pregnancy and live birth rates compared to letrozole alone? Participants will be randomized into two groups: Group 1 will receive letrozole only, starting at 2.5 mg daily from day 3 to 7 of the menstrual cycle. The dose will be increased up to 7.5 mg if no ovulation occurs, for a maximum treatment period of 6 months or until pregnancy is achieved. Group 2 will receive letrozole at the same doses as group 1 plus 25 mcg levothyroxine daily.

TRIP Database – Search: Hypothyroidism

TRIP Database

TRIP is a clinical search engine designed to allow users to quickly and easily find high-quality research evidence to support their practice. It aggregates evidence from various sources, including guidelines and systematic reviews on hypothyroidism.

TRIP Database: Hypothyroidism

TRIP Database

The TRIP Database is a clinical search engine designed to allow users to quickly and easily find high-quality research evidence to support their practice. A search for 'hypothyroidism' yields a wide array of evidence-based resources.

Cochrane Library: Hypothyroidism

Cochrane

The Cochrane Library provides a collection of systematic reviews and meta-analyses related to hypothyroidism. It is a key resource for evidence-based healthcare decisions, summarizing the best available research evidence.