JAMA Clinical Reviews Diagnosis and Management of Hypothyroidism
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Sep 3, 2025 Dr. Maria Papaleontiou, an Associate Professor of Medicine at the University of Michigan specializing in hypothyroidism research, joins to illuminate this complex condition. She discusses the prevalence and risk factors associated with hypothyroidism, emphasizing geographic and demographic influences. The conversation highlights critical symptoms like fatigue and cognitive challenges, plus the severe consequences of untreated cases, including heart failure. Dr. Papaleontiou also stresses personalized treatment approaches and the importance of monitoring treatment to avoid complications.
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Prevalence And Key Risk Factors
- Primary hypothyroidism prevalence varies widely with iodine nutrition and ranges from 0.3% to 12% worldwide.
- Hashimoto's autoimmune disease is the most common cause and risk rises with female sex, genetics, and other autoimmune conditions.
Nonspecific Clinical Presentation
- Hypothyroidism produces nonspecific metabolic slowing symptoms like fatigue, weight gain, cold intolerance, constipation, bradycardia, and cognitive impairment.
- These symptoms can overlap with many conditions, making clinical diagnosis challenging without testing.
Metabolic And Cardiovascular Effects
- Untreated hypothyroidism worsens cardiovascular risk by increasing LDL cholesterol and can worsen glucose control in diabetes via reduced insulin sensitivity.
- Clinicians should recognize these systemic metabolic effects when evaluating patients with dyslipidemia or difficult-to-control diabetes.