PERSPECTIVE article
Front. Endocrinol.
Sec. Thyroid Endocrinology
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1640663
This article is part of the Research TopicLevothyroxine Therapy in Patients with Hypothyroidism: Volume IIView all 17 articles
Seeking a Consensus for Dissatisfied Hypothyroid Patients
Provisionally accepted
- 1Sir Charles Gairdner Hospital, Perth, Australia
- 2The University of Western Australia, Perth, Australia
- 3The University of Western Australia Department of Medicine., Nedlands, Australia
- 4Sir Charles Gairdner Hospital Department of Endocrinology and Diabetes, Nedlands, Australia
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Physicians demonstrate divergent attitudes about the management of hypothyroid patients on optimal replacement with thyroxine (T4) but who complain of persisting symptoms.(i). The use of liothyronine (T3) as combination therapy in the patients who demonstrate compelling benefit is justified. These patients can be identified by a positive Woltman's sign, that is, delayed relaxation of tendon reflexes.(ii). Patients with autoimmune symptoms and elevated anti-thyroperoxidase (anti-TPO) antibodies benefit from total thyroidectomy with the attendant risks of surgical complications. Medical treatment for this subgroup requires much more research.(iii). Many physicians believe that most of the dissatisfied patients have predominantly psychosomatic symptoms, and require counselling, support, and possibly cognitive behaviour therapy.
Keywords: Hypothyroidism, persisting symptoms, combination therapy, thyroid hyporeflexia, autoimmunity psychoneurosis
Received: 04 Jun 2025; Accepted: 25 Aug 2025.
Copyright: © 2025 Welborn. 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: Tim Welborn, Sir Charles Gairdner Hospital, Perth, Australia
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