Advances in hypothyroidism management: rethinking therapy beyond levothyroxine

Abstract

Hypothyroidism, a prevalent neuroendocrine disorder characterised by insufficient thyroid hormone production and a wide spectrum of clinical manifestations, affects approximately 5% of the population, with an additional 5% remaining undiagnosed. While levothyroxine remains the golden standard of care, its inability to resolve persistent symptoms in a subset of patients highlights the need for alternative approaches. Combination levothyroxine+liothyronine therapy, though unpopular and underutilised by most physicians, offers potential benefits, particularly when tailored to mimic natural thyroid hormone ratios. Furthermore, emerging therapies show promise in reducing pharmacokinetic fluctuations that limit current advances in hypothyroidism therapy. By addressing the shortcomings of traditional therapies, these innovative approaches aim to improve the quality of life and clinical outcomes for patients with hypothyroidism, especially when the golden standard fails. This review highlights current viable options and explores emerging therapeutic strategies that could potentially optimise current treatment and quality of life, catering for all hypothyroidism patients.