(Re)defining Hypothyroidism: The Key to Patient-centered Treatment

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Background

Hypothyroidism was first described in the 19th century, with effective treatment introduced approximately two decades later. Despite large experience accumulated over a century, some modern-day patients continue to experience persistent symptoms despite appropriate treatment.

While a stated goal of the treatment of hypothyroidism is to resolve symptoms, most physicians focus on normalization of serum TSH values, which is the marker used to diagnose hypothyroidism and adjust the replacement dose of levothyroxine. However, complete physiological replacement has not been possible in other hormones deficiency syndromes, and it may be presumptuous to assume that it can easily be achieved in hypothyroidism. Given the residual symptoms and metabolic abnormalities experienced by some patients, there is therefore a need to question and redefine therapeutic success in hypothyroidism. Potential issues to consider are whether there are other biomarkers of thyroid status, in addition to TSH, that may be important, and whether different biomarkers are important for different tissues. In addition, the relevance of the origin of the hypothyroidism and how to balance benefit in long-term versus immediate clinical outcomes.

This collection seeks to compile research that (re)defines success in the treatment of patients with hypothyroidism beyond normalization of TSH levels. We welcome (mini)review, perspective, or original research articles contributing with this effort.

Potential topics include, but are not limited to:
1. (Re)definition of successful treatment of patients with hypothyroidism
2. How to correctly attribute symptoms to their underlying cause
3. Does the aetiology of hypothyroidism and/or the level of residual thyroid function matter?
4. Is TSH the best biomarker of euthyroidism?
5. The relationship between serum and tissue levels of thyroid hormones
6. How can thyroid-related quality of life questionnaires be adapted for routine clinical use?
7. How do we evaluate long-term outcomes?
8. Should T4 to T3 ratios be used to guide thyroid hormone replacement?
9. Update on restoring native thyroid function by generating thyroid follicular cells from stem cells or immunotherapy.
10. The role of exercise, sleep, and diet in reversing residual hypothyroid symptoms
11. Design of a combination therapy trial specifically designed for those with unresolved symptoms
12. Understanding why patients prefer desiccated thyroid extract

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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