Can you summarize the current treatment challenges for hypothyroidism as encountered by a broad spectrum of clinicians, including primary care, internal medicine, endocrine, women’s health, and geriatric specialists?
Well, thank you for the uh the opportunity of discussing uh hypothyroidism. Um, hypothyroidism is a very uh complex uh and uh different disease uh in the sense that uh we have an, an immense range uh of presentation of the disease. And also an immense difference in burden between patients and between patients' populations. What I mean is that uh uh probably the bulk of the population that is currently diagnosed uh and treated for uh hypothyroidism. Is a, a group of patients uh who have uh what's called subclinical hypothyroidism. Meaning uh their diagnosis uh is uh often incidental, often secondary to, um, a specific uh symptoms and uh usually driven uh by a TSH uh which is uh above normal range while uh the thyroid hormone levels uh are completely or within normal range. Um, and that, uh, uh, poses, uh, a major question to begin with. What is the burden of the, of a chronic disease or a chronic, uh, change, uh, in the, the thyroidomyostasis? And uh how is it responsible for the patient's symptoms and presentation. This is uh very challenging uh and uh requires uh an honest uh discussion uh between the provider and the patients uh uh in order to assess what would be a realistic goal and what would be a realistic uh therapeutic approach uh and uh if needed uh escalation of therapy. This is not to deny the existence of symptoms while patients are in the um subclinical hypothyroid state. But at the same point, uh, it's also very important uh recognizing that there is major overlap between Um, general, uh, uh, a specific symptoms that can be attributed that can be caused by an larger amount of comorbidities, uh, or, uh, um, life stressors for all intents and purposes. And, uh, in that case, uh, how the therapy can change is, uh, uh, is a matter for debate. Conversely, uh, subclinical hypothyroidism is also been associated uh with uh clear evidence of increase uh in cardiovascular risk. And, uh, in, uh, um, to some degree, uh, with, uh, uh, other uh comorbidities which, uh, in, uh, a mechanistic studies have been, uh, uh, improved uh by the treatment uh with uh uh thyroid hormone replacement. So this is one major point of interest that we need to consider when we are approaching a patient, when we are initiating therapy, and when we have a discussion with the patient about uh whether the therapy is working or, or not. And uh uh we need uh both uh uh in the research arena. Some good understanding on how to peg our treatment options and measurements and on the patient provider interaction, how we can establish a relationship that then can move forward as we walk through this path of treatment.
