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The History and Future of Treatment of Hypothyroidism
- Source :
- Annals of Internal Medicine. 164:50
- Publication Year :
- 2016
- Publisher :
- American College of Physicians, 2016.
-
Abstract
- Thyroid hormone replacement has been used for more than a century to treat hypothyroidism. Natural thyroid preparations (thyroid extract, desiccated thyroid, or thyroglobulin), which contain both thyroxine (T4) and triiodothyronine (T3), were the first pharmacologic treatments available and dominated the market for the better part of the 20th century. Dosages were adjusted to resolve symptoms and to normalize the basal metabolic rate and/or serum protein-bound iodine level, but thyrotoxic adverse effects were not uncommon. Two major developments in the 1970s led to a transition in clinical practice: 1) The development of the serum thyroid-stimulating hormone (TSH) radioimmunoassay led to the discovery that many patients were overtreated, resulting in a dramatic reduction in thyroid hormone replacement dosage, and 2) the identification of peripheral deiodinase-mediated T4-to-T3 conversion provided a physiologic means to justify l-thyroxine monotherapy, obviating concerns about inconsistencies with desiccated thyroid. Thereafter, l-thyroxine mono-therapy at doses to normalize the serum TSH became the standard of care. Since then, a subgroup of thyroid hormone–treated patients with residual symptoms of hypothyroidism despite normalization of the serum TSH has been identified. This has brought into question the inability of l-thyroxine monotherapy to universally normalize serum T3 levels. New research suggests mechanisms for the inadequacies of l-thyroxine monotherapy and highlights the possible role for personalized medicine based on deiodinase polymorphisms. Understanding the historical events that affected clinical practice trends provides invaluable insight into formulation of an approach to help all patients achieve clinical and biochemical euthyroidism.
- Subjects :
- Thyroid Hormones
endocrine system
medicine.medical_specialty
endocrine system diseases
Hormone Replacement Therapy
medicine.medical_treatment
Physiology
030209 endocrinology & metabolism
Article
03 medical and health sciences
0302 clinical medicine
Hypothyroidism
Thyroid-stimulating hormone
Internal medicine
Internal Medicine
medicine
Humans
Triiodothyronine
business.industry
Thyroid
Thyroidectomy
Blood Proteins
General Medicine
History, 20th Century
Transplantation
medicine.drug_formulation_ingredient
medicine.anatomical_structure
Endocrinology
030220 oncology & carcinogenesis
Thyroglobulin
Basal Metabolism
business
Thyroid extract
Biomarkers
Iodine
Protein Binding
Hormone
Subjects
Details
- ISSN :
- 00034819
- Volume :
- 164
- Database :
- OpenAIRE
- Journal :
- Annals of Internal Medicine
- Accession number :
- edsair.doi.dedup.....45c2743455a5754f105e7e426cc81471