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Standard treatment of hypothyroidism is lifelong levothyroxine (LT4) therapy [Gottwald-Hostalek, 2022; Duntas, 2019] at doses to achieve biochemical and clinical euthyroidism [Biondi, 2023]. Many hypothyroid patients start LT4 treatment at a low dose, especially the elderly, those with residual thyroid function, those with low body weight, and those with significant (especially cardiac) comorbidities [Gottwald-Hostalek, 2022]. Dose is frequently calculated based on the patient’s weight [Barrio, 2023]. Levothyroxine dose is then titrated to achieve optimum thyroid stimulating hormone (TSH) levels (0.4–4.0 mlU/L), according to the therapeutic target [Chiovato, 2019]. However, only about 30% of patients dosed according to their weight achieve target TSH levels at the first thyroid function testing after starting treatment, with obese patients frequently over-treated [Barrio, 2023]. Almost half of patients on LT4 replacement therapy demonstrate either under- or over-treatment [Gottwald-Hostalek, 2022] and still exhibit symptoms. Achieving euthyroid status in elderly patients can be especially challenging [Effraimidis, 2021]. Treatment of hypothyroidism is further complicated as some patients on LT4 remain symptomatic, despite a normal serum TSH [Wiersinga, 2019] due to a decreased serum T3/T4 ratio, with relatively lower T3 levels. Also of emerging importance is the thyroid gut axis – a bidirectional relationship between the intestinal microbiota and metabolites, which may act directly or indirectly on the thyroid by influencing intestinal microelement uptake, iodothyronine conversion and storage and immune regulation [Jiang, 2022; Stramazzo, 2023; Knezevic, 2020].
After watching this video interview, participants will be able to:
Endocrinologists and other healthcare professionals involved in the diagnosis and management of thyroid disorders.
English with voice over into Spanish and Chinese
Martin Savage is Emeritus Professor of Paediatric Endocrinology at William Harvey Research Institute, Barts and the London School of Medicine & Dentistry, Queen Mary, University of London. He was head of the Paediatric Endocrine Unit at Barts and the London School of Medicine from 1982 to 2007. He has interests in growth disorders, specifically those with abnormalities in the GH-IGF-1 axis and in phenotype-genotype relationships of GH-IGF-1 axis defects, notably GH resistance. He published the first human case of an IGF-1 gene defect in the New England Journal of Medicine in 1996. His other interests are Cushing’s syndrome and growth in chronic inflammatory diseases. He was General Secretary of the European Society for Paediatric Endocrinology (ESPE) from 1997 to 2004. He has lectured in 60 countries and has published 482 original articles, reviews, textbook chapters and books. In 2007, he was awarded the ESPE Andrea Prader Prize for contributions to paediatric endocrinology and in 2018 he received a Visionary Award from the American Human Growth Foundation. In 2022, he received a Research Excellence Award from the Dr Sulaiman Al Habib Medical Journal in Riyadh, and the British Society of Paediatric Endocrinology & Diabetes James M. Tanner Lifetime Achievement Award. He continues to lecture nationally and internationally.
Leonidas H. Duntas is Professor of Internal Medicine and Endocrinology at the University of Ulm, Germany, and at the Evgenideion Hospital, Unit of Endocrinology, Diabetes and Metabolism, University of Athens, Greece. He obtained his medical degree at the University of Bologna, Italy, following which he specialized in Internal Medicine and Endocrinology at the University of Ulm. His main clinical and research interest is clinical thyroidology, with a special focus on the impact of environment, especially of nutrients and microelements, such as selenium, and endocrine disruptors on thyroid function, thyroiditis, and cancer. Professor Duntas is Past Secretary of the European Thyroid Association (ETA), while has served as an elected member (2007-2011) of the Executive Committee of the ETA. He currently co-chairs the ETA Public Health Board. He served in several Committees of the American Thyroid Association (ATA), and he was a member of the ATA Program Organizing Committee (2021-2023) for the Centennial Meeting in 2023. He is Visiting Professor at the Universities of Beograd and Novi Sad (Serbia). Professor Leonidas Duntas is an active member of the ETA, ATA, the Hellenic Endocrine Association, the German Society of Endocrinology and the German Society of Internal Medicine. He is the author of numerous peer-reviewed original articles and reviews in renowned journals and textbooks. He is co-editor of the book Thyroid Diseases (Springer). Currently, he is Associate Editor of Thyroid, the Official Journal of the American Thyroid Association, he served as a member of the Board of various journals among others of Endocrine and J Endocrinological Investigations, and he was Deputy-in Chief Editor of Hormones, the Journal of the Hellenic Endocrine Society (2017-2022).
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