REVIEW article
Front. Endocrinol.
Sec. Thyroid Endocrinology
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1627787
This article is part of the Research TopicLevothyroxine Therapy in Patients with Hypothyroidism: Volume IIView all 14 articles
Persistent symptoms in euthyroid Hashimoto's thyroiditis: current hypotheses and emerging management strategies
Provisionally accepted
Hui Zhang1,2
wenting Tong3Weiyong Zeng2Hongyan Luo4Licai Zhang2Jiasheng Feng2Yang Xiao2*Gankun Wang2*- 1University of Rome Tor Vergata, Roma, Italy
- 2Dongguan Hospital affiliated to Guangzhou University of Chinese Medicin, Dongguan, China
- 3Gannan Healthcare Vocational College, Ganzhou, China
- 4Guangzhou University of Chinese Medicine, Guangzhou, China
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A substantial proportion of patients with Hashimoto’s thyroiditis (HT) continue to experience persistent symptoms despite achieving biochemical euthyroidism, either with or without levothyroxine (LT4) replacement therapy. Several pathophysiological mechanisms have been proposed to explain this clinical phenomenon, including a reduced free triiodothyronine to free thyroxine (FT3/FT4) ratio and persistently elevated thyroid autoantibody titers. Escalation of LT4 monotherapy is generally discouraged due to an unfavourable risk–benefit profile. In contrast, combined LT4 and liothyronine (LT3) therapy may offer symptomatic improvement in selected patients, though robust criteria for selection remain undefined. More recently, total thyroidectomy has been explored as a therapeutic option in patients with refractory symptoms, demonstrating sustained improvements in health-related quality of life compared to medical therapy. However, this surgical approach must be balanced against potential perioperative risks and complications. Adjunctive therapies, including selenium and vitamin D supplementation, have shown modest benefit. In parallel, emerging evidence has highlighted the potential of traditional Chinese medicine (TCM)—notably, herbal medicine and acupuncture—as a complementary strategy for symptom relief, although further high-quality studies are warranted. This review synthesizes current insights into the mechanisms underlying residual symptoms in HT and critically evaluates contemporary and emerging therapeutic approaches aimed at improving patient-reported outcomes and long-term disease management.
Keywords: Hashimoto's thyreoiditis, biochemical euthroidism, therapy, autoimmunity modulation, Symptoms
Received: 13 May 2025; Accepted: 27 Jun 2025.
Copyright: © 2025 Zhang, Tong, Zeng, Luo, Zhang, Feng, Xiao and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Yang Xiao, Dongguan Hospital affiliated to Guangzhou University of Chinese Medicin, Dongguan, China
Gankun Wang, Dongguan Hospital affiliated to Guangzhou University of Chinese Medicin, Dongguan, China
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