GENEMEDICS APP

GENEMEDICS NUTRITION

Thyroid Hormone
Friday, August 16th, 2019

The thyroid gland is one of the largest endocrine glands in the body located in the lower part of the neck. It produces thyroid hormones which play a major role in energy and metabolism. The thyroid does this by controlling the speed of energy usage, protein production, and sensitivity of all hormones in the body.

A healthy thyroid produces several hormones such as T1, T2, T3 (triiodothyronine), T4 (thyroxine) and calcitonin. In humans, the ratio of T4 to T3 is roughly 20 to 1. T4 is converted to the active hormone T3 which stimulates metabolism. The body, especially the liver, constantly converts T4 to Reverse T3 (RT3) to eliminate excess T4 in the body. In any given day, 40% of T4 is converted into T3 and 20% is converted to Reverse T3. But in any situation where the body needs to store energy and use it on something else such as in a stressful situation, these conversions can change – RT3 conversion can go as high as 50% or more and the T3 level goes down. When biological stress is excessive, the adrenal glands produce high amounts of the stress hormone called cortisol to help cope up with the situation and achieve balance or stability (homeostasis). The excess cortisol inhibits the conversion of T4 to T3 by affecting the ability of the pituitary gland to produce thyroid-stimulating hormone.

Overall Health Benefits of Thyroid Hormone

Thyroid Imbalance: Hyperthyroidism and Hypothyroidism

Sometimes, the ability of the thyroid gland to produce hormones can be affected by several factors or thyroid conditions, leading to abnormally low thyroid hormone (hypothyroidism) or excessive thyroid hormone (hyperthyroidism). Both hypothyroidism and hyperthyroidism can be detrimental to health and can significantly affect one’s quality of life because they increase the affected individual’s risk of developing heart disease, bone disorders, skin and hair problems, bleeding issues, sexual and reproductive concerns, and other debilitating medical conditions.

In general, people with hypothyroidism can experience the following signs and symptoms:

  • Abnormal menstrual cycles
  • Cold intolerance
  • Constipation
  • Dry or brittle hair leading to hair loss
  • Dry, pale skin
  • Extreme fatigue even in non-tiring activities
  • Higher cholesterol levels
  • Irritability, depression and low mood
  • Low libido
  • Memory problems
  • Muscle cramps and frequent muscle pains
  • Slower heart rate (bradycardia)
  • Weight gain or difficulty losing weight

On the other hand, excessive levels of thyroid hormone cause hyperthyroidism. This thyroid condition significantly increases metabolism leading to the following symptoms:

  • Anxiety
  • Bone problems
  • Breathing difficulties
  • Difficulty concentrating
  • Fatigue
  • Frequent bowel movements
  • Goiter
  • Hair loss
  • Heart palpitations
  • Heat intolerance
  • High blood pressure
  • Increased appetite
  • Increased sweating
  • Irregular menstrual cycles
  • Muscle weakness
  • Nervousness and irritability
  • Protruding, itchy eyes
  • Sleep disturbances
  • Tremors
  • Weight loss

Causes of Thyroid Problems

Problems with the thyroid gland can be caused by several conditions. For hyperthyroidism, common causes are:

  • Autoimmune diseases such as Graves’ disease.
  • Inflammation of the thyroid caused by a virus or bacteria.
  • Pituitary gland malfunctions
  • Thyroid cancer
  • Thyroid gland nodules, or non-cancerous lumps

On the other hand, hypothyroidism can be caused by the following:

  • Autoimmune diseases such as Hashimoto’s thyroiditis.
  • Certain medical treatments such as radiation therapy and thyroid surgery.
  • Certain medications such as cold and sinus medicines, amiodarone and lithium.
  • Exposure to excessive amounts of iodide (e.g. certain contrast dyes given before some X-rays)

Complexity of Thyroid Disease

Women are at higher risk for developing thyroid dysfunction. According to research, women are five to eight times more likely to have imbalance in thyroid hormones than men, but most don’t know they have it. [1] Most women often overlook their symptoms or mistake them for symptoms of other medical conditions. For example, most women who gave birth experience symptoms that are very similar to that of thyroid disease.

In young men, thyroid imbalance can be easily diagnosed with a blood test. However, as men age, thyroid imbalance becomes more difficult to diagnose because the number of symptoms often decrease. To further complicate matters, older men with thyroid imbalance often experience symptoms that are very similar to the normal symptoms of ageing. These include weight changes, low mood, depression, bone problems, cognitive decline, sleeping difficulties, hair loss, and tremors.

To address the complexity of thyroid disease in both men and women, an experienced and skilled doctor must perform a blood test that measures TSH (thyroid stimulating hormone), free T3, and T4. In addition to this, a physical exam must also be performed to assess the signs and symptoms. Once a correct diagnosis is done, your doctor will come up with a medical management that is tailored to your health needs.

Proven Benefits of Bioidentical Thyroid Hormone Replacement Therapy

In order to correct hypothyroidism, bioidentical thyroid hormones are used to restore the balance of thyroid hormones. Bioidentical hormones are safe and effective since they are chemically identical in molecular structure and function to those the human body produces. On the other hand, the medical approach to hyperthyroidism is different. This condition can be treated with anti-thyroid medications that interfere with the excessive production of thyroid hormones in order to bring down its levels to normal.

Since thyroid hormones play a major role in a wide array of biochemical processes in the body, including growth and development of tissues, breathing, energy production, regulation of heart rate, maintenance of brain function, regulation of body temperature, maintenance of the nervous system, digestion, and several other cellular processes, restoring abnormally low levels of these hormones can help alleviate debilitating symptoms and achieve optimal health and well-being. Thyroid hormone replacement has been used for more than 100 years in the treatment of thyroid hormone deficiency, and there is no doubt about its overall safety and efficacy. [2-3] In fact, an overwhelming body of scientific evidence and clinical trials support the diverse health benefits of thyroid hormone replacement therapy.

Relieves Fatigue and Boosts Energy Levels

Fatigue-related complaints are common in people with thyroid hormone deficiency. Studies assessing the beneficial effects of thyroid hormone replacement therapy in patients with hypothyroidism show that it can help boost energy levels by combating fatigue:

  1. Low thyroid hormone levels are strongly linked with extreme fatigue, suggesting that increasing thyroid hormone levels may have beneficial effects. [4-10]
  2. In patients with primary hypothyroidism, stable levothyroxine regimen for at least 6 months improves scores in a series of tests assessing fatigue. [11-12]
  3. In patients with hypothyroidism, T4 monotherapy improves symptoms of fatigue. [13]
  4. In patients with fatigue, combination of T3 and T4 therapy improves fatigue. [14]
  5. In patients with primary hypothyroidism, combination of T3 and T4 therapy decreases fatigue by improving neuropsychological function. [15]
  6. In patients with general symptoms of tiredness and hypothyroidism, thyroid hormone replacement therapy significantly reduces symptoms. [16]

Improves Mood

Thyroid disease can affect overall mood – primarily causing depression, anxiety and low self-confidence. Generally, thyroid hormone levels have something to do with the severity of mood changes, with abnormally low levels associated with severely depressed mood. There is growing evidence that thyroid hormone replacement therapy may help boost mood in people with thyroid hormone deficiency:

  1. In patients with mood disorders, thyroid hormones, usually in conjunction with standard medications, can be used to treat both manic and depressed phases of the condition. [17]
  2. In patients who had undergone surgical removal of the thyroid (thyroidectomy), combined T3 and T4 hormone replacement improves mood. [18]
  3. In patients with thyroid hormone deficiency, combination treatment of T3 and T4 significantly improves mood as well as quality of life. [19-34]
  4. In patients with mood disorders, the use of T3 helps treat symptoms by accelerating the onset of action of antidepressant therapy and enhancing the effect of treatment. [35]
  5. In patients with major depressive disorder and previous history of treatment-resistant depression, T3 supplementation is associated with a twofold greater likelihood of response to tricyclic antidepressant (TCA) therapy. [36-37]
  6. In patients with bipolar depression, supplementation of standard treatment with high-dose T4 improves mood by affecting the function of certain brain areas. [38]
  7. In patients with hypothyroidism, combination therapy of T3 and T4 appears to be effective in alleviating anxiety and depression compared to monotherapy. [39]

Strengthens the Immune System

Thyroid hormone metabolism and thyroid status are strongly associated with various aspects of the immune response. This suggests that thyroid hormones play an important role in modulating the immune system response and preventing a wide array of infections. Increasing evidence strongly supports the immune-modulating properties of thyroid hormones:

  1. Low circulating thyroid hormone levels are strongly associated with impaired immune function. [40-41]
  2. In patients with thyroid disorders, thyroid hormone supplementation prevents inflammation and other damaging immune responses. [42]
  3. In healthy men and women, combined T3 and T4 treatment improves markers of immunity. [43]
  4. Thyroid hormone administration increases size and growth of cells in the thymus, an organ that produces T cells for the immune system. [44-45]
  5. Thyroid hormones boost the activities of various immune cells such as monocytes, macrophages, natural killer cells, and white blood cells. [46-53]
  6. Thyroid hormones improve immune function by increasing the production of antibodies and other cells of the immune system. [54-58]
  7. Thyroid hormones strengthen the immune system by affecting cell-mediated immune responses. [59]
  8. In mice, T4 treatment suppresses excessive immune response such as antibody synthesis and growth of white blood cells. [60]
  9. In a cell-based study, T4 potentiates growth and reproduction of white blood cells, thereby boosting the immune response. [61]
  10. In mice, both T3 and T4 treatment enhance natural killer cell activity. [62]

Helps Lose Weight

One of the main functions of thyroid hormones is to regulate metabolism. With increased metabolism, weight loss can be achieved. Evidence suggests that thyroid hormones may actually improve body composition and reduce body weight while improving overall health:

  1. Thyroid hormones helps reduce body weight mainly through regulating energy expenditure. [63-64]
  2. Obese women appears to have low circulating levels of T4, suggesting that thyroid hormone deficiency is associated with weight gain. [65]
  3. In people undergoing weight loss diets, higher levels of T3 and T4 are associated with significant reduction in body mass index (BMI). [66]
  4. In overtly hypothyroid patients, T4 replacement therapy reduces weight by improving lean body mass. [67-68]
  5. In obese patients, administration of fresh thyroid juice reduces body weight by promoting diuresis (increased urine production). [69]
  6. In patients with hypothyroidism, T3 therapy is associated with a significant weight loss of 2.1 kg. [70]
  7. In overweight patients, T3 and T4 combination therapy significantly decreases body weight. [71-72]
  8. Thyroid hormones promote weight loss by regulating resting metabolic rate (the rate at which the body burns energy at rest). [73-74]
  9. Combination therapy of T3 and T4 appears to be more effective in reducing body weight in obese patients compared to monotherapy. [75-84]
  10. In rats, T3 promotes weight loss through regulation of lipid metabolism in the brain. [85]

Improves Cholesterol Levels

The body needs thyroid hormones in order to balance cholesterol production and elimination. In case of thyroid hormone deficiency, the body can’t make high-density lipoprotein or HDL (good cholesterol) and remove low-density lipoprotein or LDL (bad cholesterol) efficiently as usual. As a result, LDL builds up in the bloodstream which eventually leads to various debilitating diseases. Interestingly, researchers found that thyroid hormone exerts cholesterol-lowering properties which can help improve overall health:

  1. In patients with hypothyroidism and increased total cholesterol, T4 replacement therapy improves cholesterol levels by decreasing elevated LDL fraction. [86-87]
  2. In premenopausal women with hypothyroidism, combined T3 and T4 treatment appears to be more effective at improving cholesterol profile compared to monotherapy. [88]
  3. In patients with hypothyroidism, T3 or T4 administration significantly decreases total cholesterol by improving lipid metabolism. [89]
  4. In patients with primary hypothyroidism, administration of 10, 20, 25, or 50 micrograms of T3 daily on a monthly basis significantly reduces blood cholesterol levels. [90]
  5. In hypothyroid patients, T3 administration thrice daily (0.5–1.5 mIU/L) reduces total cholesterol and LDL levels. [91]
  6. In patients with hypothyroidism, T4 treatment at a dose of 1.6 microgram/kg body weight reduces total cholesterol and LDL levels. [92]
  7. In hypothyroid patients and those with normal thyroid hormone levels, T4 treatment lowers total cholesterol levels. [93]
  8. In patients with hypothyroidism, combination treatment of T3 and T4 appears to be more effective in reducing cholesterol and triglyceride levels. [94]
  9. In patients with hypothyroidism, thyroid hormone replacement therapy significantly reduces lipid and LDL levels without any adverse side effects. [95]
  10. In patients with hypothyroidism, T4 treatment reduces cholesterol levels by increasing LDL degradation. [96]
  11. In preclinical human studies, the use of thyroid hormone analogs is associated with reduced total cholesterol, LDL cholesterol, and triglycerides. [97]
  12. Long-term thyroid hormone replacement therapy lowers cholesterol levels by improving liver cholesterol metabolism. [98]
  13. Thyroid hormone replacement therapy lowers cholesterol levels by dramatically increasing intestinal absorption of cholesterol. [99]

Improves Cognitive Function

Thyroid hormone also helps regulate the growth and development of nerve cells as well as different processes in the brain. Specifically, there appears to be extensive interaction between thyroid hormones and certain brain chemicals, suggesting that healthy thyroid hormone levels may be beneficial on memory, learning, and other cognitive functions. Strong scientific evidence suggests that thyroid hormone replacement therapy can help combat cognitive impairments associated with aging and other medical conditions:

  1. Low thyroid hormone levels are strongly linked with poorer cognitive function and cognitive disorders such as Alzheimer’s disease. [100-124]
  2. On the other hand, higher thyroid hormone levels are associated with better cognitive function. [125-128]
  3. T3 helps prevent Alzheimer’s disease by inhibiting the production of amyloid beta, which are abnormal proteins and the major cause of the disease. [129-130]
  4. In pregnant women, T4 administration prevents cases of decreased child intelligence quotient. [131]
  5. In hypothyroid patients, T4 replacement therapy markedly improves cognition and emotion. [132-133]
  6. Patients with cognitive impairment appear to respond well to combined T3 and T4 therapy compared to monotherapy. [134]
  7. In patients with hypothyroidism, standard T4 monotherapy improves well-being and cognitive performance. [135]
  8. In patients with hypothyroidism, thyroid hormone replacement therapy leads to normalization of cognitive functions. [136]
  9. In hypothyroid patients, 3-month thyroid hormone replacement therapy significantly increases verbal memory retrieval. [137]
  10. In patients with hypothyroidism, thyroid hormone replacement therapy improves psychological well-being. [138]
  11. Combination T3 and T4 therapy for patients with hypothyroidism appears to be safe and effective in improving cognitive function. [139-140]
  12. In patients with hypothyroidism, T4 treatment significantly normalizes cognitive function. [141]
  13. Combined treatment of T3 and T4 in patients with hypothyroidism after thyroidectomy significantly improves mental status. [142]
  14. Successful treatment of hypothyroidism with T4 is associated with recovery or improvement of neurocognitive function and psychological well-being. [143-144]
  15. In rats, T4 administration enhances learning ability by increasing the levels of acetylcholine, a brain chemical that regulates learning and memory. [145-149]

Maintains a Healthy Heart

Thyroid hormone has important effects on heart muscle, blood circulation, and the central nervous system – all of which are vital for cardiovascular health. This suggests that thyroid hormone levels may help predict heart health. There is growing body of evidence that supports the beneficial effects of thyroid hormone on various cardiovascular markers:

  1. Thyroid hormone helps the heart pump more blood efficiently. [150]
  2. Thyroid hormone improves cardiovascular health by increasing heart rate. [151-154]
  3. Thyroid hormone improves blood circulation within the heart by increasing red blood cell production, total blood volume, and heart contractility. [155-157]
  4. Thyroid hormones also increase venous return, resulting in greater cardiac output and blood volume distributed in different body parts. [158-160]
  5. A deficiency in thyroid hormone compromises the function of the heart muscle, resulting in lower heart rate and weakening of myocardial contraction and relaxation. [161-162]
  6. Thyroid hormone deficiency also leads to lower total blood volume pumped by the heart muscle. [163-164]
  7. Low free T3 levels inhibit formation of new blood vessels in the heart tissue after a heart attack, which would accelerate heart failure and adverse cardiac events. [165-166]
  8. Thyroid hormone deficiency is also associated with abnormal heart rhythm. [167-168]
  9. In people with thyroid hormone deficiency, their risk of developing atherosclerosis (plaque formation), coronary heart disease, and heart failure is significantly increased.  [169-171]
  10. T3 and T4 administration in patients with primary hypothyroidism lower risk of cardiovascular disease by improving lipid profile and body weight. [172-181]
  11. Patients with increased thyroid hormones have increased contractile force and cardiac output. [182-187]
  12. Patients with thyroid dysfunction have reduced exercise tolerance compared to those with healthy thyroid hormone levels. [188]
  13. Evidence obtained from cell and animal models suggest that thyroid hormone treatments promote regeneration of the damaged heart muscle. [189-196]
  14. Thyroid hormone also helps maintain cardiac cell shape and growth. [197-199]
  15. Thyroid hormone protects against ischemic heart (lack of oxygen) by accelerating heart rhythm and increasing contractility. [200-201]
  16. In patients with thyroid hormone deficiency and heart disease, thyroid hormone therapy normalizes heart function and other cardiovascular parameters. [202-204]
  17. In patients with cardiomyopathy (disease of the heart muscle), T4 treatment induces significant improvement in cardiac pump function and functional capacity during exercise. [205-206]
  18. In patients with advanced heart failure and low T3 levels, higher dose of T3 improves cardiac output significantly by reducing systemic vascular resistance (resistance that must be overcome to efficiently pump blood through the circulatory system). [207-210]

Improves Bone Health

Thyroid hormone is also vital for optimum bone health. Because this hormone plays an integral role in skeletal development and establishment of peak bone mass, several high quality studies found that it can help decrease the risk of osteoporosis and other bone disorders:

  1. Deficiency or dysfunction of thyroid hormone receptors leads to growth retardation, delayed bone age, and decreased bone mineral density (BMD). [211-216]
  2. T3 regulates formation of bone cartilage and bone mineralization. [217]
  3. In men and women with thyroid hormone deficiency, there is a significant risk of decreased BMD and other bone disorders. [218-222]
  4. In patients with thyroid cancer, higher thyroid hormone levels are associated with higher femoral neck BMD. [223]
  5. In postmenopausal women, thyroid hormone level above 97.5 percentile is associated with significantly higher BMD at the femoral neck. [224]
  6. In patients with thyroid dysfunction, thyroid hormone deficiency is associated with increased femoral neck bone loss, potentially contributing to increased fracture risk. [225-226]
  7. Women with thyroid hormone levels in the lowest quartile have a higher incidence of vertebral fractures. [227]
  8. In patients with congenital hypothyroidism, treatment with thyroid hormone improves growth and BMD. [228-229]
  9. In postmenopausal women, elevated level of thyroid hormone is associated with a 5.97% increase in femoral neck bone density. [230]
  10. A thyroid disorder that affects thyroid hormone levels is considered as a cause of secondary osteoporosis. [231-232]

Improves Sleep Quality

Whether you’re having difficulty falling asleep or staying asleep, thyroid health can have a profound impact on sleep quality and quantity. This is because the thyroid gland plays an integral part in the regulation of almost all the body’s metabolic function, thus, any imbalance in thyroid hormone levels can negatively affect sleep. In fact, studies assessing the beneficial effects of thyroid hormone replacement therapy in people with sleeping problems have shown positive results:

  1. In people with sleeping disorders, the prevalence of thyroid hormone deficiency is very common. [233-244]
  2. In patients with sleep apnea syndrome (breathing repeatedly stops and starts), thyroid hormone therapy effectively alleviates snoring only after one year of treatment. [245-246]
  3. In patients with obstructive sleep apnea, T4 therapy for 4 months significantly reduces periods of absent breathing during sleep. [247]
  4. T4 therapy in patients with subclinical hypothyroidism and obstructive sleep apnea is associated with less daytime sleepiness. [248]
  5. One study reported that 50–100% of patients with hypothyroidism and obstructive sleep apnea showed an improvement in sleep-disordered breathing with T4 replacement. [249]
  6. In patients with sleep apnea, thyroid hormone replacement therapy reverses symptoms and sleep-disordered breathing. [250]
  7. In patients with sleep-disordered breathing associated with hypothyroidism, T4 replacement therapy alone significantly improves sleep apnea by reducing the total number of episodes of obstructive apnea and improving oxygen saturation during sleep. [251-252]
  8. In patients with sleep apnea associated with hypothyroidism, combination of continuous positive airway pressure and low-dose T4 therapy improves sleep quality. [253]
  9. In patients with obstructive sleep apnea associated with hypothyroidism, thyroid hormone replacement therapy significantly improves sleep quality especially in non-obese patients. [254]
  10. In patients with newly diagnosed sleep-disordered breathing, T4 therapy alone improves breathing patterns, nocturnal hypoxia (diminished oxygen supply at night), and thyroid deficiency. [255]
  11. In patients with hypothyroidism and sleep apnea, T4 replacement therapy significantly improves sleep respiratory abnormalities. [256-258]

Improves Blood Pressure

Thyroid hormone also has a role in blood pressure regulation. After all, there are thyroid receptors found in every cell of your body, thus, fluctuations in the levels of thyroid hormone can significantly affect blood pressure. There is increasing evidence that restoring thyroid hormone to optimal levels may be beneficial in people with hypertension:

  1. Thyroid hormone deficiency is strongly linked with hypertension. [259-266]
  2. In patients with hypertension, thyroid hormone replacement therapy decreases blood pressure by reducing blood vessel stiffness. [267]
  3. T3 has vasodilatory properties, which means that it has the ability to dilate blood vessels, thereby lowering blood pressure. [268-270]
  4. Thyroid hormone lowers blood pressure by reducing vasopressin, a hormone that increases blood pressure by promoting water retention. [271-272]
  5. In patients with hypothyroidism, T4 replacement therapy for 3-6 months significantly reduces blood pressure. [273]
  6. In patients with hypothyroidism, low-dose T4 replacement therapy reduces blood pressure by improving blood vessel function. [274]
  7. In patients with hypertension related to hypothyroidism, thyroid hormone replacement therapy successfully reduces blood pressure without any adverse side effects. [275]
  8. In hypertensive patients, adequate thyroid hormone replacement therapy improves blood pressure by reversing increased central aortic pressures and arterial stiffness. [276]
  9. Thyroid hormones participate in the control of systemic arterial blood pressure homeostasis (balance). [277]

Improves Kidney Function

There are several interactions between thyroid hormone and kidney functions. In fact, thyroid hormones are involved in the development of the kidney and they aid in waste excretion by improving the kidney’s filtering ability. Evidence suggests that thyroid hormone replacement therapy may help improve kidney function and prevent various kidney disorders:

  1. Thyroid hormone deficiency is strongly associated with kidney disease and impaired kidney function. [278-300]
  2. In patients with overt hypothyroidism, T4 treatment improves kidney function. [301-305]
  3. T4 treatment in patients with subclinical hypothyroidism and chronic kidney disease (CKD) significantly lowers the rate of decline in glomerular filtration rate (kidney’s ability to filter waste). [306-307]
  4. In patients with hypothyroidism, T4 replacement therapy reverses edema (fluid build-up) associated with kidney disease. [308]
  5. In patients with various kidney diseases, T4 treatment alleviates urine protein loss.    [309-313]
  6. Thyroid hormone replacement therapy attenuates the rate of decline in kidney function in CKD patients with hypothyroidism, suggesting that the treatment may delay reaching end-stage renal disease in these patients. [314-318]
  7. In patients with hypothyroidism and CKD, thyroid hormone therapy not only preserves kidney function better, but is also an independent predictor of kidney outcomes. [319]
  8. In elderly patients and those with kidney disease, thyroid hormone therapy preserves kidney function by improving glomerular filtration rate. [320-323]
  9. In patients with kidney impairment secondary to hypothyroidism, thyroid hormone replacement therapy reverses kidney dysfunction. [324-325]
  10. In patients with primary hypothyroidism, T4 administration normalizes glomerular filtration rate and blood flow to the kidney. [326-332]
  11. In patients with kidney impairment caused by hypothyroidism, T4 treatment improves water excretion by the kidney. [333]
  12. In patients with kidney disease, T4 replacement therapy improves kidney function by reducing creatinine, a waste product of muscle breakdown. [334]

References:

  1. Pereira JC, Pradella-Hallinan M, de Lins Pessoa H. Imbalance between thyroid hormones and the dopaminergic system might be central to the pathophysiology of restless legs syndrome: a hypothesis. Clinics. 2010;65(5):548-554. doi:10.1590/S1807-59322010000500013.
  2. Wiersinga WM. Thyroid hormone replacement therapy. Horm Res. 2001;56 Suppl 1:74-81.
  3. McAninch EA, Bianco AC. The History and Future of Treatment of Hypothyroidism. Annals of internal medicine. 2016;164(1):50-56. doi:10.7326/M15-1799.
  4. Louwerens M, Appelhof BC, Verloop H, et al. Fatigue and fatigue-related symptoms in patients treated for different causes of hypothyroidism. Eur J Endocrinol. 2012;167(6):809-15.
  5. Kaltsas G, Vgontzas A, Chrousos G. Fatigue, endocrinopathies, and metabolic disorders. PM R. 2010;2(5):393-8.
  6. Bunevicius A, Gintauskiene V, Podlipskyte A, et al. Fatigue in patients with coronary artery disease: association with thyroid axis hormones and cortisol. Psychosom Med. 2012;74(8):848-53.
  7. Esposito SPrange  AJ  JrGolden  RN The thyroid axis and mood disorders: overview and future prospects. Psychopharmacol Bull 1997;33 (2) 205- 217.
  8. Duyff RFVan den Bosch  JLaman  DMvan Loon  BJLinssen  WH Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study.  J Neurol Neurosurg Psychiatry 2000;68 (6) 750- 755.
  9. Tielens ETPillay  MStorm  CBerghout  A Changes in cardiac function at rest before and after treatment in primary hypothyroidism.  Am J Cardiol 2000;85 (3) 376- 380.
  10. Den Hollander JGWulkan  RWMantel  MJBerghout  A Correlation between severity of thyroid dysfunction and renal function.  Clin Endocrinol (Oxf) 2005;62 (4) 423- 427.
  11. Bolk N, Visser TJ, Nijman J, Jongste IJ, Tijssen JG, Berghout A. Effects of evening vs morning levothyroxine intake: a randomized double-blind crossover trial. Arch Intern Med. 2010;170(22):1996-2003.
  12. Smets EMGarssen  BBonke  BDe Haes  JC The Multidimensional Fatigue Inventory (MFI): psychometric qualities of an instrument to assess fatigue.  J Psychosom Res 1995;39 (3) 315- 325.
  13. Grozinsky-Glasberg S, Fraser A, Nahshoni E, Weizman A, Leibovici L. Thyroxine-triiodothyronine combination therapy versus thyroxine monotherapy for clinical hypothyroidism: meta-analysis of randomized controlled trials. J Clin Endocrinol Metab. 2006;91:2592–9. doi: 10.1210/jc.2006-0448.
  14. Rodriguez T, Lavis VR, Meininger JC, Kapadia AS, Stafford LF. 2005Substitution of liothyronine at a 1:5 ratio for a portion of levothyroxine: effect on fatigue, symptoms of depression, and working memory versus treatment with levothyroxine alone. Endocr Pract 11:223–233.
  15. Bunevicius R, Kazanavicius G, Zalinkevicius R, Prange AJ., Jr 1999Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism. N Engl J Med 340:424–429.
  16. Murray JS, Jayarajasingh R, Perros P. Deterioration of symptoms after start of thyroid hormone replacement. BMJ : British Medical Journal. 2001;323(7308):332-333.
  17. Esposito S, Prange AJ, Golden RN. The thyroid axis and mood disorders: overview and future prospects. Psychopharmacol Bull. 1997;33(2):205-17.
  18. Bunevicius R, Jakuboniene N, Jakubonien N, et al. Thyroxine vs thyroxine plus triiodothyronine in treatment of hypothyroidism after thyroidectomy for Graves’ disease. Endocrine. 2002;18(2):129-33.
  19. Rodriguez T, Lavis VR, Meininger JC, Kapadia AS, Stafford LF. 2005Substitution of liothyronine at a 1:5 ratio for a portion of levothyroxine: effect on fatigue, symptoms of depression, and working memory versus treatment with levothyroxine alone. Endocr Pract 11:223–233.
  20. Walsh JP, Shiels L, Lim EM, Bhagat CI, Ward LC, Stuckey BG, Dhaliwal SS, Chew GT, Bhagat MC, Cussons AJ. 2003Combined thyroxine/liothyronine treatment does not improve well-being, quality of life, or cognitive function compared to thyroxine alone: a randomized controlled trial in patients with primary hypothyroidism. J Clin Endocrinol Metab 88:4543–4550.
  21. Appelhof BC, Fliers E, Wekking EM, Schene AH, Huyser J, Tijssen JG, Endert E, van Weert HC, Wiersinga WM. 2005Combined therapy with levothyroxine and liothyronine in two ratios, compared with levothyroxine monotherapy in primary hypothyroidism: a double-blind, randomized, controlled clinical trial. J Clin Endocrinol Metab 90:2666–2674.
  22. Bunevicius R, Kazanavicius G, Zalinkevicius R, Prange AJ., Jr 1999Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism. N Engl J Med 340:424–429.
  23. Sawka AM, Gerstein HC, Marriott MJ, MacQueen GM, Joffe RT. 2003Does a combination regimen of thyroxine (T4) and 3,5,3′-triiodothyronine improve depressive symptoms better than T4 alone in patients with hypothyroidism? Results of a double-blind, randomized, controlled trial. J Clin Endocrinol Metab 88:4551–4555.
  24. Bunevicius R, Jakubonien N, Jurkevicius R, Cernicat J, Lasas L, Prange AJ., Jr 2002Thyroxine vs thyroxine plus triiodothyronine in treatment of hypothyroidism after thyroidectomy for Graves’ disease. Endocrine 18:129–133.
  25. Clyde PW, Harari AE, Getka EJ, Shakir KM. 2003Combined levothyroxine plus liothyronine compared with levothyroxine alone in primary hypothyroidism: a randomized controlled trial. JAMA 290:2952–2958.
  26. Escobar-Morreale HF, Botella-Carretero JI, Gomez-Bueno M, Galan JM, Barrios V, Sancho J. 2005Thyroid hormone replacement therapy in primary hypothyroidism: a randomized trial comparing L-thyroxine plus liothyronine with L-thyroxine alone. Ann Intern Med 142:412–424.
  27. Nygaard B, Jensen EW, Kvetny J, Jarlov A, Faber J. 2009Effect of combination therapy with thyroxine (T4) and 3,5,3′-triiodothyronine versus T4 monotherapy in patients with hypothyroidism, a double-blind, randomised cross-over study. Eur J Endocrinol 161:895–902.
  28. Saravanan P, Simmons DJ, Greenwood R, Peters TJ, Dayan CM. 2005Partial substitution of thyroxine (T4) with tri-iodothyronine in patients on T4 replacement therapy: results of a large community-based randomized controlled trial. J Clin Endocrinol Metab 90:805–812.
  29. Siegmund W, Spieker K, Weike AI, Giessmann T, Modess C, Dabers T, Kirsch G, Sanger E, Engel G, Hamm AO, Nauck M, Meng W. 2004Replacement therapy with levothyroxine plus triiodothyronine (bioavailable molar ratio 14 : 1) is not superior to thyroxine alone to improve well-being and cognitive performance in hypothyroidism. Clin Endocrinol 60:750–757.
  30. Valizadeh M, Seyyed-Majidi MR, Hajibeigloo H, Momtazi S, Musavinasab N, Hayatbakhsh MR. 2009Efficacy of combined levothyroxine and liothyronine as compared with levothyroxine monotherapy in primary hypothyroidism: a randomized controlled trial. Endocr Res 34:80–89.
  31. Grozinsky-Glasberg S, Fraser A, Nahshoni E, Weizman A, Leibovici L. 2006Thyroxine-triiodothyronine combination therapy versus thyroxine monotherapy for clinical hypothyroidism: meta-analysis of randomized controlled trials. J Clin Endocrinol Metab 91:2592–2599.
  32. Escobar-Morreale HF, Botella-Carretero JI, Escobar del Rey F, Morreale de Escobar G. 2005Review: treatment of hypothyroidism with combinations of levothyroxine plus liothyronine. J Clin Endocrinol Metab 90:4946–4954.
  33. Joffe RT, Brimacombe M, Levitt AJ, Stagnaro-Green A. 2007Treatment of clinical hypothyroidism with thyroxine and triiodothyronine: a literature review and metaanalysis. Psychosomatics 48:379–384.
  34. Ma C, Xie J, Huang X, Wang G, Wang Y, Wang X, Zuo S. 2009Thyroxine alone or thyroxine plus triiodothyronine replacement therapy for hypothyroidism. Nucl Med Commun 30:586–593.
  35. Cooper-Kazaz R, Lerer B. 2008Efficacy and safety of triiodothyronine supplementation in patients with major depressive disorder treated with specific serotonin reuptake inhibitors. Int J Neuropsychopharmacol 11:685–699.
  36. Aronson R, Offman HJ, Joffe RT, Naylor CD. 1996Triiodothyronine augmentation in the treatment of refractory depression. A meta-analysis. Arch Gen Psychiatry 53:842–848.
  37. Cooper-Kazaz R, Lerer B. 2008Efficacy and safety of triiodothyronine supplementation in patients with major depressive disorder treated with specific serotonin reuptake inhibitors. Int J Neuropsychopharmacol 11:685–699.
  38. Bauer M, London ED, Rasgon N, et al. Supraphysiological doses of levothyroxine alter regional cerebral metabolism and improve mood in bipolar depression. Mol Psychiatry. 2005;10(5):456-69.
  39. Nygaard B, Jensen EW, Kvetny J, Jarløv A, Faber J. Effect of combination therapy with thyroxine (T4) and 3,5,3′-triiodothyronine versus T4 monotherapy in patients with hypothyroidism, a double-blind, randomised cross-over study. Eur J Endocrinol. 2009;161(6):895-902.
  40. Foster MP, Montecino-Rodriguez E, Dorshkind K. Proliferation of bone marrow pro-B cells is dependent on stimulation by the pituitary/thyroid axis. J Immunol. 1999;163:5883–5889.
  41. Dorshkind K, Horseman ND. The roles of prolactin, growth hormone, insulin-like growth factor-I, and thyroid hormones in lymphocyte development and function: Insights from genetic models of hormone and hormone receptor deficiency. Endocrine Rev. 2005;21:292–312.
  42. Nagataki S, Eguchi K. Cytokines and immune regulation in thyroid autoimmunity. Autoimmunity. 1992;13(1):27-34.
  43. Hodkinson CF, Simpson EE, Beattie JH, et al. Preliminary evidence of immune function modulation by thyroid hormones in healthy men and women aged 55-70 years. J Endocrinol. 2009;202(1):55-63.
  44. Dardenne M, Savino W, Bach JF. Modulation of thymic endocrine function by thyroid and steroid hormones. Int J Neurosci. 1988;39(3-4):325-34.
  45. Lam SH, Sin YM, Gong Z, Lam TJ. Effects of thyroid hormone on the development of immune system in zebrafish. Gen Comp Endocrinol. 2005;142(3):325-35.
  46. Jara EL, Muñoz-durango N, Llanos C, et al. Modulating the function of the immune system by thyroid hormones and thyrotropin. Immunol Lett. 2017;184:76-83.
  47. Coutelier JP, Kehrl JH, Bellur SS, Kohn LD, Notkins AL, Prabhakar BS. Binding and functional effects of thyroid stimulating hormone to human immune cells. J Clin Immunol. 1990;10:204–210.
  48. Bagriacik EU, Klein JR. The thyrotropin (thyroid stimulating hormone) receptor is expressed on murine dendritic cells and on a subset of CD43RBhigh lymph node T cells: Functional role of thyroid stimulating hormone during immune activation. J Immunol. 2000;164:6158–6165.
  49. Kruger TE. Immunomodulation of peripheral lymphocytes by hormones of the hypothalamus-pituitary-thyroid axis. Adv Neuroimmunol. 1996;6:387–395.
  50. Fabris N, Mochegiani E, Provinciali M. Pituitary-thyroid axis and immune system: A reciprocal neuroendocrine-immune interaction. Horm Res. 1995;43:29–38.
  51. Provinciali M, Di Stefano G, Fabris N. Improvement in the proliferative capacity and natural killer cell activity of murine spleen lymphocytes by thyrotropin. Int J Immunopharmacol. 1992;14:865–870.
  52. Whetsell M, Bagriacik EU, Seetharamaiah GS, Prabhakar BS, Klein JR. Neuroendocrine-induced synthesis of bone marrow-derived cytokines with inflammatory immunomodulating properties. Cell Immunol. 1999;192:159–166.
  53. Wang H-C, Dragoo J, Zhou Q, Klein JR. An intrinsic thyrotropin-mediated pathway of TNFα production by bone marrow cells. Blood. 2003;101:119–123.
  54. Smith EM, Phan M, Kruger TE, Coppenhaver DH, Blalock JE. Human lymphocyte production of immunoreactive thyrotropin. Proc Natl Acad Sci USA. 1982;80:6010–6013.
  55. Kruger TE, Blalock JE. Cellular requirements for thyrotropin enhancement of in vitro antibody production. J Immunol. 1986;137:197–200.
  56. Blalock JE, Johnson HM, Smith EM, Torres BA. Enhancement of the in vitro antibody response by thyrotropin. Biochem Biophys Res Comm. 1984;25:30–34.
  57. Kruger TE, Blalock JE. Cellular requirements for thyrotropin enhancement of in vitro antibody production. J Immunol. 1986;137:197–200.
  58. Kruger TE, Smith EM, Harbour DV, Blalock JE. Thyrotropin: an endogenous regulator of the in vitro immune response. J Immunol. 1989;142:744–747.
  59. De vito P, Incerpi S, Pedersen JZ, Luly P, Davis FB, Davis PJ. Thyroid hormones as modulators of immune activities at the cellular level. Thyroid. 2011;21(8):879-90.
  60. Gupta MK, Chiang T, Deodhar SD. Effect of thyroxine on immune response in C57Bl/6J mice. Acta Endocrinol. 1983;103(1):76-80.
  61. Ong ML, Malkin DG, Malkin A. Alteration of lymphocyte reactivities by thyroid hormones. Int J Immunopharmacol. 1986;8(7):755-62.
  62. Provinciali M, Fabris N. Modulation of lymphoid cell sensitivity to interferon by thyroid hormones. J Endocrinol Invest. 1990;13(2):187-91.
  63. Reinehr T. Obesity and thyroid function. Mol Cell Endocrinol. 2010;316(2):165–71.
  64. Mullur R, Liu YY, Brent GA. Thyroid hormone regulation of metabolism. Physiol Rev. 2014;94(2):355–82.
  65. Shon HS, Jung ED, Kim SH, Lee JH. Free T4 is negatively correlated with body mass index in euthyroid women. Korean J Intern Med. 2008;23(2):53-7.
  66. Liu G, Liang L, Bray GA, et al. Thyroid hormones and changes in body weight and metabolic parameters in response to weight loss diets: the POUNDS LOST trial. Int J Obes (Lond). 2017;41(6):878-886.
  67. Sánchez A, Carretto H, Ulla MR, Capozza R. Body composition of patients with primary hypothyroidism evaluated by dual-energy X-ray absorptiometry and its changes after treatment with levo-thyroxine. Endocrinologist. 2004;14:321–327.
  68. Karmisholt J, Andersen S, Laurberg P. Weight loss after therapy of hypothyroidism is mainly caused by excretion of excess body water associated with myxoedema. J Clin Endocrinol Metab. 2011;96:99–103.
  69. Fenwick EH. The diuretic action of fresh thyroid juice. BMJ. 1891;2:798–799.
  70. Celi FS, Zemskova M, Linderman JD, Smith S, Drinkard B, Sachdev V, Skarulis MC, Kozolsky M, Csako G, Costello R, Pucino F. Metabolic effects of liothyronine therapy in hypothyroidism: a randomized, double-blind crossover trial of liothyronine versus levothyroxine. J Clin Endocrinol Metab. 2011;96:3466–3474.
  71. Appelhof BC, Fliers E, Wekking EM, Schene AH, Huyser J, Tijssen JG, Endert E, van Weert HC, Wiersinga WM. Combined therapy with levothyroxine and liothyronine in two ratios, compared with levothyroxine monotherapy in primary hypothyroidism: a double-blind, randomized, controlled clinical trial. J Clin Endocrinol Metab. 2005;90:2666–2674.
  72. Grozinsky-Glasberg S, Fraser A, Nahshoni E, Weizman A, Leibovici L. Thyroxine-triiodothyronine combination therapy versus thyroxine monotherapy for clinical hypothyroidism: meta-analysis of randomized controlled trials. J Clin Endocrinol Metab. 2006;91:2592–2599.
  73. Haber RS, Loeb JN. Stimulation of potassium efflux in rat liver by a low dose of thyroid hormone: evidence for enhanced cation permeability in the absence of Na,K-ATPase induction. Endocrinology. 1986;118(1):207–11.
  74. Silva JE. Thermogenic mechanisms and their hormonal regulation. Physiol Rev. 2006;86(2):435–64.
  75. Rodriguez T, Lavis VR, Meininger JC, Kapadia AS, Stafford LF. 2005Substitution of liothyronine at a 1:5 ratio for a portion of levothyroxine: effect on fatigue, symptoms of depression, and working memory versus treatment with levothyroxine alone. Endocr Pract 11:223–233.
  76. Walsh JP, Shiels L, Lim EM, Bhagat CI, Ward LC, Stuckey BG, Dhaliwal SS, Chew GT, Bhagat MC, Cussons AJ. 2003Combined thyroxine/liothyronine treatment does not improve well-being, quality of life, or cognitive function compared to thyroxine alone: a randomized controlled trial in patients with primary hypothyroidism. J Clin Endocrinol Metab 88:4543–4550.
  77. Appelhof BC, Fliers E, Wekking EM, Schene AH, Huyser J, Tijssen JG, Endert E, van Weert HC, Wiersinga WM. 2005Combined therapy with levothyroxine and liothyronine in two ratios, compared with levothyroxine monotherapy in primary hypothyroidism: a double-blind, randomized, controlled clinical trial. J Clin Endocrinol Metab 90:2666–2674.
  78. Bunevicius R, Jakubonien N, Jurkevicius R, Cernicat J, Lasas L, Prange AJ., Jr 2002Thyroxine vs thyroxine plus triiodothyronine in treatment of hypothyroidism after thyroidectomy for Graves’ disease. Endocrine 18:129–133.
  79. Clyde PW, Harari AE, Getka EJ, Shakir KM. 2003Combined levothyroxine plus liothyronine compared with levothyroxine alone in primary hypothyroidism: a randomized controlled trial. JAMA 290:2952–2958.
  80. Escobar-Morreale HF, Botella-Carretero JI, Gomez-Bueno M, Galan JM, Barrios V, Sancho J. 2005Thyroid hormone replacement therapy in primary hypothyroidism: a randomized trial comparing L-thyroxine plus liothyronine with L-thyroxine alone. Ann Intern Med 142:412–424.
  81. Nygaard B, Jensen EW, Kvetny J, Jarlov A, Faber J. 2009Effect of combination therapy with thyroxine (T4) and 3,5,3′-triiodothyronine versus T4 monotherapy in patients with hypothyroidism, a double-blind, randomised cross-over study. Eur J Endocrinol 161:895–902.
  82. Saravanan P, Simmons DJ, Greenwood R, Peters TJ, Dayan CM. 2005Partial substitution of thyroxine (T4) with tri-iodothyronine in patients on T4 replacement therapy: results of a large community-based randomized controlled trial. J Clin Endocrinol Metab 90:805–812.
  83. Siegmund W, Spieker K, Weike AI, Giessmann T, Modess C, Dabers T, Kirsch G, Sanger E, Engel G, Hamm AO, Nauck M, Meng W. 2004Replacement therapy with levothyroxine plus triiodothyronine (bioavailable molar ratio 14 : 1) is not superior to thyroxine alone to improve well-being and cognitive performance in hypothyroidism. Clin Endocrinol 60:750–757.
  84. Valizadeh M, Seyyed-Majidi MR, Hajibeigloo H, Momtazi S, Musavinasab N, Hayatbakhsh MR. 2009Efficacy of combined levothyroxine and liothyronine as compared with levothyroxine monotherapy in primary hypothyroidism: a randomized controlled trial. Endocr Res 34:80–89.
  85. López M, Varela L, Vázquez MJ, Rodriguez-Cuenca S, González R, Velagapudi VR, Morgan DA, Schoenmakers E, Agassandian K, Lage R, Martinez de Morentin PB, Tovar S, Nogueiras R, Carling D, Lelliott C, Gallego R, Orešič M, Chatterjee K, Saha AK, Rahmouni K, Diéguez C, Vidal-Puig A. Hypothalamic AMPK and fatty acid metabolism mediate thyroid regulation of energy balance. Nat Med. 2010;16:1001–1008.
  86. Pacifico L, Anania C, Ferraro F, Andreoli GM, Chiesa C. 2012Thyroid function in childhood obesity and metabolic comorbidity. Clin Chim Acta 413:396–405.
  87. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung, and Blood Institute 2011Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics 128(Suppl 5):S213–S256.
  88. Fadeyev VV, Morgunova TB, Melnichenko GA, Dedov II. Combined therapy with L-thyroxine and L-triiodothyronine compared to L-thyroxine alone in the treatment of primary hypothyroidism. Hormones (Athens). 2010;9(3):245-52.
  89. Celi FS, Zemskova M, Linderman JD, et al. Metabolic effects of liothyronine therapy in hypothyroidism: a randomized, double-blind, crossover trial of liothyronine versus levothyroxine. J Clin Endocrinol Metab. 2011;96(11):3466-74.
  90. Ridgway EC, Cooper DS, Walker H, et al. Therapy of primary hypothyroidism with L-triiodothyronine: discordant cardiac and pituitary responses. Clin Endocrinol (Oxf). 1980;13(5):479-88.
  91. Celi FS, Zemskova M, Linderman JD, Smith S, Drinkard B, Sachdev V, Skarulis MC, Kozlosky M, Csako G, Costello R, Pucino F. 2011Metabolic effects of liothyronine therapy in hypothyroidism: a randomized, double-blind, crossover trial of liothyronine versus levothyroxine. J Clin Endocrinol Metab 96:3466–3474.
  92. Slawik M, Klawitter B, Meiser E, et al. Thyroid hormone replacement for central hypothyroidism: a randomized controlled trial comparing two doses of thyroxine (T4) with a combination of T4 and triiodothyronine. J Clin Endocrinol Metab. 2007;92(11):4115-22.
  93. Zulewski H, Müller B, Exer P, Miserez AR, Staub JJ. Estimation of tissue hypothyroidism by a new clinical score: evaluation of patients with various grades of hypothyroidism and controls. J Clin Endocrinol Metab. 1997;82(3):771-6.
  94. Grozinsky-glasberg S, Fraser A, Nahshoni E, Weizman A, Leibovici L. Thyroxine-triiodothyronine combination therapy versus thyroxine monotherapy for clinical hypothyroidism: meta-analysis of randomized controlled trials. J Clin Endocrinol Metab. 2006;91(7):2592-9.
  95. Martínez-triguero ML, Hernández-mijares A, Nguyen TT, et al. Effect of thyroid hormone replacement on lipoprotein(a), lipids, and apolipoproteins in subjects with hypothyroidism. Mayo Clin Proc. 1998;73(9):837-41.
  96. Duntas LH, Brenta G. Thyroid hormones: a potential ally to LDL-cholesterol-lowering agents. Hormones (Athens). 2016;15(4):500-510.
  97. Delitala AP, Delitala G, Sioni P, Fanciulli G. Thyroid hormone analogs for the treatment of dyslipidemia: past, present, and future. Curr Med Res Opin. 2017;33(11):1985-1993.
  98. Pazos F, Alvarez JJ, Rubiés-prat J, Varela C, Lasunción MA. Long-term thyroid replacement therapy and levels of lipoprotein(a) and other lipoproteins. J Clin Endocrinol Metab. 1995;80(2):562-6.
  99. Gälman C, Bonde Y, Matasconi M, Angelin B, Rudling M. Dramatically increased intestinal absorption of cholesterol following hypophysectomy is normalized by thyroid hormone. Gastroenterology. 2008;134(4):1127-36.
  100. Quinlan P, Nordlund A, Lind K, Gustafson D, Edman Å, Wallin A. Thyroid Hormones Are Associated with Poorer Cognition in Mild Cognitive Impairment. Dementia and Geriatric Cognitive Disorders. 2010;30(3):205-211. doi:10.1159/000319746.
  101. Parsaik AK, Singh B, Roberts RO, et al. Hypothyroidism and Risk of Mild Cognitive Impairment in Elderly Persons – A Population Based Study. JAMA neurology. 2014;71(2):201-207. doi:10.1001/jamaneurol.2013.5402.
  102. Gan EH, Pearce SHS. The Thyroid in Mind: Cognitive Function and Low Thyrotropin in Older People. The Journal of Clinical Endocrinology and Metabolism. 2012;97(10):3438-3449. doi:10.1210/jc.2012-2284.
  103. Hu Y, Wang Z, Guo Q, Cheng W, Chen Y. Is thyroid status associa ted with cognitive impairment in elderly patients in China? BMC Endocrine Disorders. 2016;16:11. doi:10.1186/s12902-016-0092-z.
  104. Bajaj S, Sachan S, Misra V, Varma A, Saxena P. Cognitive function in subclinical hypothyroidism in elderly. Indian Journal of Endocrinology and Metabolism. 2014;18(6):811-814. doi:10.4103/2230-8210.141355.
  105. Paoletti AM, Congia S, Lello S, Tedde D, Orru M, Pistis M, Pilloni M, Zedda P, Loddo A, Melis GB. Low androgenization index in elderly women and elderly men with Alzheimer’s disease. Neurology. 2004;62:301–303.
  106. Watanabe T, Miyazaki A, Katagiri T, Yamamoto H, Idei T, Iguchi T. Relationship between serum insulin-like growth factor-1 levels and Alzheimer’s disease and vascular dementia. J Am Geriatr Soc. 2005;53:1748–1753.
  107. Ganguli M, Burmeister LA, Seaberg EC, Belle S, DeKosky ST. Association between dementia and elevated TSH: a community-based study. Biol Psychiatry. 1996;40:714–725.
  108. Tan ZS, Beiser A, Vasan RS, et al. Thyroid function and the risk of Alzheimer disease: the Framingham Study. Archives of internal medicine. 2008 Jul 28;168(14):1514–1520.
  109. Knopman DS, DeKosky ST, Cummings JL, et al. Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001 May 8;56(9):1143–1153.
  110. Baldini IM, Vita A, Mauri MC, et al. Psychopathological and cognitive features in subclinical hypothyroidism. Prog Neuropsychopharmacol Biol Psychiatry. 1997 Aug;21(6):925–935.
  111. Haggerty JJ, Jr, Garbutt JC, Evans DL, et al. Subclinical hypothyroidism: a review of neuropsychiatric aspects. International journal of psychiatry in medicine. 1990;20(2):193–208.
  112. Jensovsky J, Ruzicka E, Spackova N, Hejdukova B. Changes of event related potential and cognitive processes in patients with subclinical hypothyroidism after thyroxine treatment. Endocrine regulations. 2002 Sep;36(3):115–122.
  113. Monzani F, Del Guerra P, Caraccio N, et al. Subclinical hypothyroidism: neurobehavioral features and beneficial effect of L-thyroxine treatment. The Clinical investigator. 1993 May;71(5):367–371.
  114. Resta F, Triggiani V, Barile G, et al. Subclinical hypothyroidism and cognitive dysfunction in the elderly. Endocrine, metabolic & immune disorders drug targets. 2012 Sep;12(3):260–267.
  115. Kim JM, Stewart R, Kim SY, et al. Thyroid stimulating hormone, cognitive impairment and depression in an older korean population. Psychiatry investigation. 2010 Dec;7(4):264–269.000
  116. Kramer CK, von Muhlen D, Kritz-Silverstein D, Barrett-Connor E. Treated hypothyroidism, cognitive function, and depressed mood in old age: the Rancho Bernardo Study. European journal of endocrinology/European Federation of Endocrine Societies. 2009 Dec;161(6):917–921.
  117. Lopez O, Huff FJ, Martinez AJ, Bedetti CD. Prevalence of thyroid abnormalities is not increased in Alzheimer’s disease. Neurobiology of aging. 1989 May-Jun;10(3):247–251.
  118. Shalat SL, Seltzer B, Pidcock C, Baker EL., Jr Risk factors for Alzheimer’s disease: a case-control study. Neurology. 1987 Oct;37(10):1630–1633.
  119. Small GW, Matsuyama SS, Komanduri R, Kumar V, Jarvik LF. Thyroid disease in patients with dementia of the Alzheimer type. Journal of the American Geriatrics Society. 1985 Aug;33(8):538–539.
  120. Breteler MM, van Duijn CM, Chandra V, et al. Medical history and the risk of Alzheimer’s disease: a collaborative re-analysis of case-control studies. EURODEM Risk Factors Research Group. International journal of epidemiology. 1991;20(Suppl 2):S36–S42.
  121. Erlanger DM, Kutner KC, Jacobs AR. Hormones and cognition: current concepts and issues in neuropsychology. Neuropsychology review. 1999 Dec;9(4):175–207.
  122. Osterweil D, Syndulko K, Cohen SN, et al. Cognitive function in non-demented older adults with hypothyroidism. Journal of the American Geriatrics Society. 1992 Apr;40(4):325–335.
  123. van der Cammen TJ, Mattace-Raso F, van Harskamp F, de Jager MC. Lack of association between thyroid disorders and Alzheimer’s disease in older persons: a cross-sectional observational study in a geriatric outpatient population. Journal of the American Geriatrics Society. 2003 Jun;51(6):884.
  124. Annerbo S, Wahlund LO, Lökk J. 2006. The significance of thyroid-stimulating hormone and homocysteine in the development of Alzheimer’s disease in mild cognitive impairment: a 6-year follow-up study. Am J Alzheimers Dis Other Demen 21:182–188.
  125. Prinz PN, Scanlan JM, Vitaliano PP, Moe KE, Borson S, Toivola B, Merriam GR, Larsen LH, Reed HL. 1999. Thyroid hormones: positive relationships with cognition in healthy, euthyroid older men. J Gerontol A Biol Sci Med Sci 54:M111–M116.
  126. Gussekloo J, van Exel E, de Craen AJ, Meinders AE, Frölich M, Westendorp RG. 2004. Thyroid status, disability and cognitive function, and survival in old age. JAMA 292:2591–259.
  127. Wahlin A, Bunce D, Wahlin TB. 2005. Longitudinal evidence of the impact of normal thyroid stimulating hormone variations on cognitive functioning in very old age. Psychoneuroendocrinology 30:625–637.
  128. Beydoun MA, Beydoun HA, Kitner-triolo MH, Kaufman JS, Evans MK, Zonderman AB. Thyroid hormones are associated with cognitive function: moderation by sex, race, and depressive symptoms. J Clin Endocrinol Metab. 2013;98(8):3470-81.
  129. Latasa MJ, Belandia B, Pascual A. 1998. Thyroid hormones regulate β-amyloid gene splicing and protein secretion in neuroblastoma cells. Endocrinology 139:2692–2698.
  130. Belandia B, Latasa MJ, Villa A, Pascual A. 1998. Thyroid hormone negatively regulates the transcriptional activity of the β-amyloid precursor protein gene. J Biol Chem 273:30366–30371.
  131. Dosiou C, Barnes J, Schwartz A, Negro R, Crapo L, Stagnaro-Green A. Cost–effectiveness of universal and risk-based screening for autoimmune thyroid disease in pregnant women. J. Clin. Endocrinol. Metab. 97(5), 1536–1546 (2012).
  132. Resta F, Triggiani V, Barile G, et al. Subclinical hypothyroidism and cognitive dysfunction in the elderly. Endocr Metab Immune Disord Drug Targets. 2012;12(3):260-267.
  133. Santos NC, Costa P, Ruano D, et al. Revisiting thyroid hormones in schizophrenia. J Thyroid Res. 2012;2012:569147.
  134. Dayan C, Panicker V. Management of hypothyroidism with combination thyroxine (T4) and triiodothyronine (T3) hormone replacement in clinical practice: a review of suggested guidance. Thyroid Research. 2018;11:1. doi:10.1186/s13044-018-0045-x.
  135. Siegmund W, Spieker K, Weike AI, et al. Replacement therapy with levothyroxine plus triiodothyronine (bioavailable molar ratio 14 : 1) is not superior to thyroxine alone to improve well-being and cognitive performance in hypothyroidism. Clin Endocrinol (Oxf). 2004;60(6):750-7.
  136. Capet C, Jego A, Denis P, et al. [Is cognitive change related to hypothyroidism reversible with replacement therapy?]. Rev Med Interne. 2000;21(8):672-8.
  137. Miller KJ, Parsons TD, Whybrow PC, et al. Memory improvement with treatment of hypothyroidism. Int J Neurosci. 2006;116(8):895-906.
  138. Saravanan P, Visser TJ, Dayan CM. Psychological well-being correlates with free thyroxine but not free 3,5,3′-triiodothyronine levels in patients on thyroid hormone replacement. J Clin Endocrinol Metab. 2006;91(9):3389-93.
  139. Wartofsky L. Combination L-T3 and L-T4 therapy for hypothyroidism. Curr Opin Endocrinol Eiabetes Obes. 2013;20:460–466. [PubMed] A recent comprehensive review of combination L-T4/L-T3 therapy in hypothyroidism.
  140. Wiersinga WM. Paradigm shifts in thyroid hormone replacement therapies for hypothyroidism. Nat Rev Endocrinol. 2014;10:164–174. [PubMed] A recent comprehensive review of combination L-T4/L-T3 therapy in hypothyroidism.
  141. Bunevicius R Kazanavicius G Zalinkevicius R et al. Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism. N Engl J Med . 1999;340:424–429.
  142. Bunevicius R Jakubonien N Jurkevicius R et al. Thyroxine vs thyroxine plus triiodothyronine in treatment of hypothyroidism after thyroidectomy for Graves’ disease. Endocrine . 2002;18:129–133.
  143. Samuels MH , Schuff KG , Carlson NE , Carello P , Janowsky JS 2007 Health status, psychological symptoms, mood, and cognition in L-thyroxine-treated hypothyroid subjects. Thyroid 17:249–258.
  144. Saravanan P , Chau WF , Roberts N , Vedhara K , Greenwood R , Dayan CM 2002 Psychological well-being in patients on ‘adequate’ doses of L-thyroxine: results of a large, controlled community-based questionnaire study. Clin Endocrinol (Oxf) 57:577–585.
  145. Smith JW, Evans AT, Costall B, Smythe JW. 2002. Thyroid hormones, brain function and cognition: a brief review. Neurosci Biobehav Rev 26:45–60.
  146. Giovannini MG, Casamenti F, Nistri A, Paoli F, Pepeu G. 1991. Effect of thyrotropin releasing hormone (TRH) on acetylcholine release from different brain areas investigated by microdialysis. Br J Pharmacol 102:363–368.
  147. Brunello N, Cheney DL. 1981. The septal-hippocampal cholinergic pathway: role in antagonism of pentobarbital anesthesia and regulation by various afferents. J Pharmacol Exp Ther 219:489–495.
  148. Malthe-Sorenssen D, Wood PL, Cheney DL, Costa E. 1978. Modulation of the turnover rate of acetylcholine in rat brain by intraventricular injections of thyrotropin-releasing hormone, somatostatin, neurotensin and angiotensin II. J Neurochem 31:685–691.
  149. Smith JW, Evans AT, Costall B, Smythe JW. Thyroid hormones, brain function and cognition: a brief review. Neurosci Biobehav Rev. 2002;26(1):45-60.
  150. Mohr-kahaly S, Kahaly G, Meyer J. [Cardiovascular effects of thyroid hormones]. Z Kardiol. 1996;85 Suppl 6:219-31.
  151. Nordyke RA, Gilbert Jr FI, Harada AS 1988 Graves’ disease. Influence of age on clinical findings. Arch Intern Med 148:626–631.
  152. DeGroot LJ 1972 Thyroid and the heart. Mayo Clin Proc 47:864–871.
  153. Klein I 1990 Thyroid hormone and the cardiovascular system. Am J Med 88:631–637.
  154. D. Pennock, T. E. Raya, J. J. Bahl, S. Goldman, and E. Morkin, “Cardiac effects of 3,5-diiodothyropropionic acid, a thyroid hormone analog with inotropic selectivity,” Journal of Pharmacology and Experimental Therapeutics, vol. 263, no. 1, pp. 163–169, 1992.
  155. Graettinger JS, Muenster JJ, Selverstone LA, Campbell JA 1959 A correlation of clinical and hemodynamic studies in patients with hyperthyroidism with and without congestive heart failure. J Clin Invest 39:1316–1327.
  156. Gibson JG, Harris AW 1939 Clinical studies on the blood volume: V. Hyperthyroidism and myxedema. J Clin Invest 18:59–65.
  157. Klein I, Levey GS 1984 Unusual manifestations of hypothyroidism. Arch Intern Med 144:123–128.
  158. Woeber KA. Thyrotoxicosis and the heart. N Engl J Med. 1992; 327: 94-8.
  159. Fadel BM, Ellahham S, Ringel MD, Lindsay J, Wartofsky L, Burman KD. Hyperthyroid heart disease. Clin Cardiol. 2000; 23: 402-8.
  160. Toft AD, Boon NA. Thyroid disease and the heart. Heart. 2000; 84: 455-60.
  161. Galetta F,Franzoni F, Fallahi P, Tocchini L, Braccini L, et al. (2008) Changes in heart rate variability and QT dispersion in patients with overt hypothyroidism.Eur J Endocrinol 158: 85-90.
  162. Faber J, Selmer C (2014) Cardiovascular disease and thyroid function.Front Horm Res 43: 45-56.
  163. Ozturk S,Alcelik A, Ozyasar M, Dikbas O, Ayhan S, et al. (2012) Evaluation of left ventricular systolic asynchrony in patients with subclinical hypothyroidism.Cardiol J 19: 374-380.
  164. Zonstein J, Fein F, Sonnenblick E (1994) The heart and endocrine disease. In: Schlant R, Alexander R (eds) The heart, arteries and veins. (8thedn) McGraw-Hill, New York 1907-1921.
  165. Yamanaka S,Kumon Y, Matsumura Y, Kamioka M, Takeuchi H, et al. (2010) Link between pericardial effusion and attenuation of QRS voltage in patients with hypothyroidism.Cardiology 116: 32-36.
  166. Yamanaka S,Kumon Y, Matsumura Y, Kamioka M, Takeuchi H, et al. (2010) Link between pericardial effusion and attenuation of QRS voltage in patients with hypothyroidism.Cardiology 116: 32-36.
  167. Selmer C,Olesen JB, Hansen ML, Lindhardsen J, Olsen AM, et al. (2012) The spectrum of thyroid disease and risk of new onset atrial fibrillation: a large population cohort study.BMJ 345: e7895.
  168. Bielecka-Dabrowa A,Mikhailidis DP, Rysz J, Banach M (2009) The mechanisms of atrial fibrillation in hyperthyroidism.Thyroid Res 2: 4.
  169. Cappola AR , Ladenson PW 2003 Hypothyroidism and atherosclerosis. J Clin Endocrinol Metab 88:2438–2444.
  170. Rodondi N , Bauer DC , Cappola AR , Cornuz J , Robbins J , Fried LP , Ladenson PW , Vittinghoff E , Gottdiener JS , Newman AB 2008 Subclinical thyroid dysfunction, cardiac function, and the risk of heart failure. The Cardiovascular Health Study. J Am Coll Cardiol 52:1152–1159.
  171. Rodondi N , den Elzen WP , Bauer DC , Cappola AR , Razvi S , Walsh JP , Asvold BO , Iervasi G , Imaizumi M , Collet TH , Bremner A , Maisonneuve P , Sgarbi JA , Khaw KT , Vanderpump MP , Newman AB , Cornuz J , Franklyn JA , Westendorp RG , Vittinghoff E , Gussekloo J 2010 Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA 304:1365–1374.
  172. Lomenick JP , El-Sayyid M , Smith WJ 2008 Effect of levo-thyroxine treatment on weight and body mass index in children with acquired hypothyroidism. J Pediatr 152:96–100.
  173. Franklyn JA , Daykin J , Betteridge J , Hughes EA , Holder R , Jones SR , Sheppard MC 1993 Thyroxine replacement therapy and circulating lipid concentrations. Clin Endocrinol (Oxf) 38:453–459.
  174. al-Adsani H , Hoffer LJ , Silva JE 1997 Resting energy expenditure is sensitive to small dose changes in patients on chronic thyroid hormone replacement. J Clin Endocrinol Metab 82:1118–1125.
  175. Clyde PW , Harari AE , Getka EJ , Shakir KM 2003 Combined levothyroxine plus liothyronine compared with levothyroxine alone in primary hypothyroidism: a randomized controlled trial. JAMA 290:2952–2958.
  176. Saravanan P , Simmons DJ , Greenwood R , Peters TJ , Dayan CM 2005 Partial substitution of thyroxine (T4) with tri-iodothyronine in patients on T4 replacement therapy: results of a large community-based randomized controlled trial. J Clin Endocrinol Metab 90:805–812.
  177. Escobar-Morreale HF , Botella-Carretero JI , Gómez-Bueno M , Galán JM , Barrios V , Sancho J 2005 Thyroid hormone replacement therapy in primary hypothyroidism: a randomized trial comparing L-thyroxine plus liothyronine with L-thyroxine alone. Ann Intern Med 142:412–424.
  178. Siegmund W , Spieker K , Weike AI , Giessmann T , Modess C , Dabers T , Kirsch G , Sänger E , Engel G , Hamm AO , Nauck M , Meng W 2004 Replacement therapy with levothyroxine plus triiodothyronine (bioavailable molar ratio 14:1) is not superior to thyroxine alone to improve well-being and cognitive performance in hypothyroidism. Clin Endocrinol (Oxf) 60:750–757.
  179. Appelhof BC , Fliers E , Wekking EM , Schene AH , Huyser J , Tijssen JG , Endert E , van Weert HC , Wiersinga WM 2005 Combined therapy with levothyroxine and liothyronine in two ratios, compared with levothyroxine monotherapy in primary hypothyroidism: a double-blind, randomized, controlled clinical trial. J Clin Endocrinol Metab 90:2666–2674.
  180. Fadeyev VV , Morgunova TB , Sytch JP , Melnichenko GA 2005 TSH and thyroid hormones concentrations in patients with hypothyroidism receiving replacement therapy with L-thyroxine alone or in combination with L-triiodothyronine. Hormones 4:101–107.
  181. Regalbuto C , Maiorana R , Alagona C , Paola RD , Cianci M , Alagona G , Sapienza S , Squatrito S , Pezzino V 2007 Effects of either LT4 monotherapy or LT4/LT3 combined therapy in patients totally thyroidectomized for thyroid cancer. Thyroid 17:323–331.
  182. Mintz G, Pizzarello R, Klein I. Enhance left diastolic function in hyperthyroidism: noninvasive assessment and response to treatment. J Clin Endocrinol Metab. 1991; 73: 146-50.
  183. Rohrer DK, Hartong R, Dillmann WH. Influence of thyroid hormone and retinoic acid on slow sarcoplasmic reticulum Ca ATPase and myosin heavy chain alpha gene expression in cardiac myocytes. J Biol Chem. 1991; 266: 8638-46.
  184. Klein I, Ojamaa K. Cardiovascular manifestations of endocrine disease. J Clin Endocrinol Metab. 1992; 75:339-42.
  185. Polikar R, Burger AG, Scherrer U, Nicod P. The thyroid and the heart. Circulation. 1993; 87: 1435-41.
  186. Ojamaa K, Balkamn C, Klein I. Acute effects of t3 on vascular smooth muscle cells. Ann Thorac Surg. 1993; 56: 568.
  187. Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system: from theory to practice. J Clin Endocrinol Metab. 1994; 78: 1026-7.
  188. Kahaly GJ, Kampmann C, Mohr-Kahaly S. Cardiovascular hemodynamics and exercise tolerance in thyroid disease. Thyroid. 2002; 12, 6: 473-81.
  189. Pantos, I. Mourouzis, and D. V. Cokkinos, “Thyroid hormone as a therapeutic option for treating ischaemic heart disease: from early reperfusion to late remodelling,” Vascular Pharmacology, vol. 52, no. 3-4, pp. 157–165, 2010.
  190. K. Henderson, S. Danzi, J. T. Paul, G. Leya, I. Klein, and A. M. Samarel, “Physiological replacement of T3 improves left ventricular function in an animal model of myocardial infarction-induced congestive heart failure,” Circulation: Heart Failure, vol. 2, no. 3, pp. 243–252, 2009.
  191. F. Chen, S. Kobayashi, J. Chen et al., “Short term triiodo-L-thyronine treatment inhibits cardiac myocyte apoptosis in border area after myocardial infarction in rats,” Journal of Molecular and Cellular Cardiology, vol. 44, no. 1, pp. 180–187, 2008.
  192. Pantos, I. Mourouzis, K. Markakis et al., “Thyroid hormone attenuates cardiac remodeling and improves hemodynamics early after acute myocardial infarction in rats,” European Journal of Cardio-thoracic Surgery, vol. 32, no. 2, pp. 333–339, 2007.
  193. Pantos, I. Mourouzis, K. Markakis, N. Tsagoulis, M. Panagiotou, and D. V. Cokkinos, “Long-term thyroid hormone administration reshapes left ventricular chamber and improves cardiac function after myocardial infarction in rats,” Basic Research in Cardiology, vol. 103, no. 4, pp. 308–318, 2008.
  194. Forini, V. Lionetti, H. Ardehali et al., “Early long-term L-T3 replacement rescues mitochondria and prevents ischemic cardiac remodelling in rats,” Journal of Cellular and Molecular Medicine, vol. 15, no. 3, pp. 514–524, 2011.
  195. Kalofoutis, I. Mourouzis, G. Galanopoulos et al., “Thyroid hormone can favorably remodel the diabetic myocardium after acute myocardial infarction,” Molecular and Cellular Biochemistry, vol. 345, no. 1-2, pp. 161–169, 2010.
  196. Pantos, I. Mourouzis, N. Tsagoulis et al., “Thyroid hormone at supra-physiological dose optimizes cardiac geometry and improves cardiac function in rats with old myocardial infarction,” Journal of Physiology and Pharmacology, vol. 60, no. 3, pp. 49–56, 2009.
  197. W. Linnane and H. Eastwood, “Cellular redox regulation and prooxidant signaling systems: a new perspective on the free radical theory of aging,” Annals of the New York Academy of Sciences, vol. 1067, no. 1, pp. 47–55, 2006.
  198. S. R. Araujo, P. Schenkel, A. T. Enzveiler et al., “The role of redox signaling in cardiac hypertrophy induced by experimental hyperthyroidism,” Journal of Molecular Endocrinology, vol. 41, no. 5-6, pp. 423–430, 2008.
  199. Pantos, Ch. Xinaris, I. Mourouzis, V. Malliopoulou, E. Kardami, and D. V. Cokkinos, “Thyroid hormone changes cardiomyocyte shape and geometry via ERK signaling pathway: potential therapeutic implications in reversing cardiac remodeling?” Molecular and Cellular Biochemistry, vol. 297, no. 1-2, pp. 65–72, 2007.
  200. I. Pantos, V. A. Malliopoulou, I. S. Mourouzis et al., “Long-term thyroxine administration protects the heart in a pattern similar to ischemic preconditioning,” Thyroid, vol. 12, no. 4, pp. 325–329, 2002.
  201. Shulga, A. Blaesse, K. Kysenius et al., “Thyroxin regulates BDNF expression to promote survival of injured neurons,” Molecular and Cellular Neuroscience, vol. 42, no. 4, pp. 408–418, 2009.
  202. W. Ladenson, S. I. Sherman, K. L. Baughman, P. E. Ray, and A. M. Feldman, “Reversible alterations in myocardial gene expression in a young man with dilated cardiomyopathy and hypothyroidism,” Proceedings of the National Academy of Sciences of the United States of America, vol. 89, no. 12, pp. 5251–5255, 1992.
  203. S. Colucci, “Molecular and cellular mechanisms of myocardial failure,” The American Journal of Cardiology, vol. 80, no. 11A, pp. 15L–25L, 1997.
  204. I. Khalife, YI. D. Tang, J. A. Kuzman et al., “Treatment of subclinical hypothyroidism reverses ischemia and prevents myocyte loss and progressive LV dysfunction in hamsters with dilated cardiomyopathy,” American Journal of Physiology, vol. 289, no. 6, pp. H2409–H2415, 2005.
  205. Moruzzi, E. Doria, and P. G. Agostoni, “Medium-term effectiveness of L-thyroxine treatment in idiopathic dilated cardiomyopathy,” American Journal of Medicine, vol. 101, no. 5, pp. 461–467, 1996.
  206. Moruzzi, E. Doria, P. G. Agostoni, V. Capacchione, and P. Sganzerla, “Usefulness of L-thyroxine to improve cardiac and exercise performance in idiopathic dilated cardiomyopathy,” The American Journal of Cardiology, vol. 73, no. 5, pp. 374–378, 1994.
  207. Degens, A. J. Gilde, M. Lindhout, P. H. M. Willemsen, G. J. van der Vusse, and M. van Bilsen, “Functional and metabolic adaptation of the heart to prolonged thyroid hormone treatment,” American Journal of Physiology, vol. 284, no. 1, pp. H108–H115, 2003.
  208. A. Hamilton, L. W. Stevenson, G. C. Fonarow et al., “Safety and hemodynamic effects of intravenous triiodothyronine in advanced congestive heart failure,” The American Journal of Cardiology, vol. 81, no. 4, pp. 443–447, 1998.
  209. Moruzzi, E. Doria, and P. G. Agostoni, “Medium-term effectiveness of L-thyroxine treatment in idiopathic dilated cardiomyopathy,” American Journal of Medicine, vol. 101, no. 5, pp. 461–467, 1996.
  210. Iervasi, M. Emdin, R. M. P. Colzani et al., “Beneficial effects of long-term triiodothyronine (T3) infusion in patients with advanced heart failure and low T3 syndrome,” in Proceedings of the 2nd International Congress on Heart Disease—New Trends in Research, Diagnosis and Treatment, A. Kimchi, Ed., pp. 549–553, Medimond Medical Publications, Washington, DC, USA, 2001.
  211. Basset J, Williams G. The molecular actions of thyroid hormone in bone. Trends Endocrinol Metab. 2003;14:356–364. doi: 10.1016/S1043-2760(03)00144-9.
  212. Gautier K. Genetic analysis reveals different functions for the products of the thyroid hormone receptors α locus. Mol Cell Biol. 2001;21:4748–4760. doi: 10.1128/MCB.21.14.4748-4760.2001.
  213. Harvey C, O’Shea P, Scott A, Robson H, Siebler T, Shalet S, Samarut J, Chassande O, Williams G. Molecular mechanisms of thyroid hormone effects on bone growth and function. Mol Genet Metab. 2002;75:17–30. doi: 10.1006/mgme.2001.3268.
  214. Basset J, Williams G. Critical role of the hypothalamic-pituitary-thyroid axis in bone. Bone. 2008;43:418–426. doi: 10.1016/j.bone.2008.05.007.
  215. Stevens D, Harvey C, Scott A, Williams A, Jackson D, O’Shea P, Williams G. Thyroid hormone activates fibroblast growth factor receptor-1 in bone. Mol Endocrinol. 2003;17:1751–1766. doi: 10.1210/me.2003-0137.
  216. Williams GR. Actions of thyroid hormones in bone. Endokrynol Pol. 2009;60(5):380-8.
  217. Wexler J, Sharretts J. Thyroid and bone. Endocrinol Metab Clin N Am. 2007;36:373–705. doi: 10.1016/j.ecl.2007.04.005.
  218. Tuchendler D, Bolanowski M. The influence of thyroid dysfunction on bone metabolism. Thyroid Research. 2014;7:12. doi:10.1186/s13044-014-0012-0.
  219. Tárraga López PJ, López CF, de Mora FN, et al. Osteoporosis in patients with subclinical hypothyroidism treated with thyroid hormone. Clinical Cases in Mineral and Bone Metabolism. 2011;8(3):44-48.
  220. Dhanwal DK. Thyroid disorders and bone mineral metabolism. Indian Journal of Endocrinology and Metabolism. 2011;15(Suppl2):S107-S112. doi:10.4103/2230-8210.83339.
  221. Waung JA , Bassett JH , Williams GR 2012 Thyroid hormone metabolism in skeletal development and adult bone maintenance. Trends Endocrinol Metab 23:155–162.
  222. Bassett JH, Williams AJ, Murphy E, et al. A lack of thyroid hormones rather than excess thyrotropin causes abnormal skeletal development in hypothyroidism. Mol Endocrinol. 2008;22(2):501-12.
  223. Heemstra KA, Van der deure WM, Peeters RP, et al. Thyroid hormone independent associations between serum TSH levels and indicators of bone turnover in cured patients with differentiated thyroid carcinoma. Eur J Endocrinol. 2008;159(1):69-76.
  224. Grimnes G, Emaus N, Joakimsen RM, Figenschau Y, Jorde R. The relationship between serum TSH and bone mineral density in men and postmenopausal women: The Tromsø study. Thyroid. 2008;18:1147–55.
  225. Segna D, Bauer DC, Feller M, et al. Association between subclinical thyroid dysfunction and change in bone mineral density in prospective cohorts. J Intern Med. 2018;283(1):56-72.
  226. Amashukeli M, Giorgadze E, Tsagareli M, Nozadze N, Jeiranashvili N. The impact of thyroid diseases on bone metabolism and fracture risk. Georgian Med News. 2010;(184-185):34-9.
  227. Mazziotti G, Porcelli T, Patelli I, Vescovi PP, Giustina A. Serum TSH values and risk of vertebral fractures in euthyroid post-menopausal women with low bone mineral density. Bone 2010;46:747-75.
  228. Kooh SW, Brnjac L, Ehrlich RM, Qureshi R, Krishnan S. Bone mass in children with congenital hypothyroidism treated with thyroxine since birth. Journal of Pediatrics Endocrinology and Metabolism 1996;9:59-62.
  229. Leger J, Ruiz JC, Guibourdenche J, Kindermans C, Garabedian M, Czernichow P, et al. Bone mineral density and metabolism in children with congenital hypothyroidism after prolonged 1-thyroxine therapy. Acta Paediatrica 1997;86:704-10.
  230. Grimnes G, Emaus N, Joakimsen RM, Figenschau Y, Jorde R. The relationship between serum TSH and bone mineral density in men and postmenopausal women: The Tromsø study. Thyroid 2008; 18:1147-55.
  231. Dhanwal DK, Dennison EM, Harvey NC, Cooper C. et al. Epidemiology of hip fracture: Worldwide geographic variation. Indian J Orthop 2011; 45:15-22.
  232. Dhanwal DK, Cooper C, Dennison EM. Geographic variation in osteoporotic hip fracture incidence: The growing importance of Asian influences in coming decades. J Osteoporos 2010; 757102.
  233. Bahammam SA, Sharif MM, Jammah AA, Bahammam AS. Prevalence of thyroid disease in patients with obstructive sleep apnea. Respir Med. 2011;105(11):1755-60.
  234. W. Winkelman, H. Goldman, N. Piscatelli, S.E. Lukas, C.M. Dorsey, S. Cunningham Are thyroid function tests necessary in patients with suspected sleep apnea? Sleep, 19 (10) (1996 Dec), pp. 790-793.
  235. Grunstein. Obstructive sleep apnea syndrome and hypothyroidism Chest, 105 (4) (1994 Apr), pp. 1296-1297.
  236. K. Kapur, T.D. Koepsell, J. deMaine, R. Hert, R.E. Sandblom, B.M. Psaty Association of hypothyroidism and obstructive sleep apnea Am J Respir Crit Care Med, 158 (5 Pt 1) (1998 Nov), pp. 1379-1383.
  237. M. Miller, A.M. Husain Should women with obstructive sleep apnea syndrome be screened for hypothyroidism? Sleep Breath, 7 (4) (2003 Dec), pp. 185-188.
  238. M. Skjodt, R. Atkar, P.A. Easton Screening for hypothyroidism in sleep apnea Am J Respir Crit Care Med, 160 (2) (1999 Aug), pp. 732-735.
  239. Alotair, A. Bahammam Gender differences in Saudi patients with obstructive sleep apnea Sleep Breath, 12 (4) (2008 Nov), pp. 323-329.
  240. B. Pham, A.F. Shaughnessy Should we treat subclinical hypothyroidism? BMJ, 337 (2008), pp. 290-291.
  241. H. Brix, P.S. Hansen, K.O. Kyvik, L. Hegedus Cigarette smoking and risk of clinically overt thyroid disease: a population-based twin case-control study.
  242. Sichieri, J. Baima, T. Marante, M.T. de Vasconcellos, A.S. Moura, M. Vaisman Low prevalence of hypothyroidism among black and Mulatto people in a population-based study of Brazilian women Clin Endocrinol (Oxf), 66 (6) (2007 Jun), pp. 803-807.
  243. Lin C., Tsan K., Chen P.The relationship between sleep apnea syndrome and hypothyroidism. Chest102199216631667.
  244. Meslier N., Giraud P., Person C., Badatcheff A., Racineux J. L.Prevalence of hypothyroidism in sleep apnoea syndrome. Eur. J. Med.11992437438.
  245. Lin CC, Tsan KW, Chen PJ. The relationship between sleep apnea syndrome and hypothyroidism. Chest. 1992;102(6):1663-7.
  246. Misiolek, B. Marek, G. Namyslowski, W. Scierski, K. Zwirska-Korczala, Z. Kazmierczak-Zagorska, D. Kajdaniuk, H. Misiolek. Sleep apnea syndrome and snoring in patients with hypothyroidism with relation to overweight.
  247. Rajagopal, K. R., Abbrecht, P. H., Derderian, S. S., Pickett, C., Hofeldt, F., Tellis, C. J. & Zwillich, C. W. 1984. Obstructive sleep apnea in hypothyroidism. Ann Intern Med, 101, 491-4.
  248. Resta, O., Carratu, P., Carpagnano, G. E., Maniscalco, M., Di Gioia, G., Lacedonia, D., Giorgino, R. & De Pergola, G. 2005. Influence of subclinical hypothyroidism and T4 treatment on the prevalence and severity of obstructive sleep apnoea syndrome (OSAS). J Endocrinol Invest, 28, 893-8.
  249. K. Kapur, T.D. Koepsell, J. deMaine, R. Hert, R.E. Sandblom, B.M. Psaty Association of hypothyroidism and obstructive sleep apnea. Am. J. Respir. Crit. Care Med., 158 (5 Pt 1) (1998), pp. 1379-1383.
  250. Mete, Y. Yalcin, D. Berker, B. Ciftci, S. Guven Firat, O. Topaloglu, H. Cinar Yavuz, S. Guler. Relationship between obstructive sleep apnea syndrome and thyroid diseases. Endocrine, 44 (3) (2013), pp. 723-728.
  251. M. Skjodt, R. Atkar, P.A. Easton. Screening for hypothyroidism in sleep apnea. Am. J. Respir. Crit. Care Med., 160 (1999), pp. 732-773.
  252. Ashish Jhaa, Surendra K. Sharmaa, Nikhil Tandonb, Ramakrishnan Lakshmyc, Tamilarasu Kadhiravana, K.K. Handad, Rajiva Guptaa, Ravindra M. Pandeye. Thyroxine replacement therapy reverses sleep-disordered breathing in patients with primary hypothyroidism. Sleep Med., 7 (2006), pp. 55-61.
  253. R. Grunstein. Sullivan ce Sleep apnea and hypothyroidism: mechanisms and management Am. J. Med., 85 (6) (1989), pp. 775-779.
  254. C. Villar, H. Saconato, O. Valente, A.N. Atallah. Cochrane Thyroid hormone replacement for subclinical hypothyroidism. Database Syst. Rev., 18 (3) (2007), p. CD003419.
  255. Skjodt NM, Atkar R, Easton PA. Screening for hypothyroidism in sleep apnea. Am J Respir Crit Care Med. 1999;160(2):732-5.
  256. Millman R. P., Bevilacqua J., Peterson D. D., Pack A. I.Central sleep apnea in hypothyroidism. Am. Rev. Respir. Dis.1271983504507.
  257. Orr W. C., Males J. L., Imes N. K.Myxedema and obstructive sleep apnea. Am. J. Med.70198110611066.
  258. Skatrud J., Iber C., Ewart R., Thomas G., Rasmussen H., Schultze B.Disordered breathing during sleep in hypothyroidism. Am. Rev. Respir. Dis.1241981325329.
  259. Streeten DH, Anderson GH, Howland T, Chiang R, Smulyan H. Effects of thyroid function on blood pressure. Recognition of hypothyroid hypertension. Hypertension. 1988;11(1):78-83.
  260. Endo T, Komiya I, Tsukui T, Yamada T, Izumiyama T, Nagata H, Kono S, Kamata K 1979 Re-evaluation of a possible high incidence of hypertension in hypothyroid patients. Am Heart J 98:684–688.
  261. Saito I, Ito K, Saruta T 1983 Hypothyroidism as a cause of hypertension. Hypertension 5:112–115.
  262. Klein I 1989 Thyroid hormone and high blood pressure. In: Laragh JH, Brenner BM, Kaplan NM, eds. Endocrine mechanisms in hypertension. New York: Raven Press; vol 2:61–80.
  263. Klein I 1990 Thyroid hormone and the cardiovascular system. Am J Med 88:631–637.
  264. Fletcher AK, Weetman AP 1998 Hypertension and hypothyroidism. J Hum Hypertens 12:79–82.
  265. Graettinger JS, Muenster JJ, Checchia CS, Grissom RL, Campbell JA 1958 A correlation of clinical and hemodynamic studies in patients with hypothyroidism. J Clin Invest 19:502–510.
  266. Streeten DH, Anderson GH Jr, Howland T, Chiang R, Smulyan H1988 Effects of thyroid function on blood pressure. Recognition of hypothyroid hypertension. Hypertension 11:78–83.
  267. Dernellis J, Panaretou M. Effects of thyroid replacement therapy on arterial blood pressure in patients with hypertension and hypothyroidism. Am Heart J. 2002;143(4):718-24.
  268. Haber RS, Loeb JN 1982 Effect of 3,5,3-triiodothyronine treatment on potassium efflux from isolated rat diaphragm: role of increased permeability in the thermogenic response. Endocrinology 111:1217–1223.
  269. Klein I, Ojamaa K 1994 Thyroid hormone and the cardiovascular system: from theory to practice [Editorial]. J Clin Endocrinol Metab 78:1026–1227.
  270. Klein I, Ojamaa K 2001 Thyroid hormone and the cardiovascular system. N Engl J Med 344:501–509.
  271. Skowsky RW, Kikuchi TA 1978 The role of vasopressin in the impaired water excretion of myxedema. Am J Med 64:613–621.
  272. Hanna FWF, Scanlon MF 1997 Hyponatraemia, hypothyroidism and the role of arginine-vasopressin. Lancet 350:755–756.
  273. Kumar S, Rungta S, Gutch M, Bhattacharya A, Razi SMohd, Avinash A. The Effect of Thyroid Hormone Replacement on the Level of Blood Pressure in the Cases of Subclinical Hypothyroidism. International Journal of Medicine and Public Health. 2018;8(1):24-28.
  1. Available at https://journals.lww.com/jhypertension/Abstract/2015/06001/PP_09_05___THE_IMPACT_OF_THYROID_HORMONE.632.aspx.
  2. Ichiki T. Thyroid hormone and atherosclerosis. Vascul. Pharmacol. 52, 151–156 (2010).
  3. Obuobie K, Smith J, Evans M et al. Increased central arterial stiffness in hypothyroidism. J. Clin. Endocrinol. Metab. 87(10), 4662–4666 (2002).
  4. Fommei E, Iervasi G. The role of thyroid hormone in blood pressure homeostasis: evidence from short-term hypothyroidism in humans. J Clin Endocrinol Metab. 2002;87(5):1996-2000.
  5. Rhee CM, Kalantar-zadeh K, Streja E, et al. The relationship between thyroid function and estimated glomerular filtration rate in patients with chronic kidney disease. Nephrol Dial Transplant. 2015;30(2):282-7.
  6. Meuwese CL, Gussekloo J, De craen AJ, Dekker FW, Den elzen WP. Thyroid status and renal function in older persons in the general population. J Clin Endocrinol Metab. 2014;99(8):2689-96.
  7. Montenegro J, Gonzalez O, Saracho R, Aguirre R, Gonzalez O, Martinez I. Changes in renal function in primary hypothyroidism. Am J Kidney Dis . 1996;27(2):195–198.
  8. Kreisman SH, Hennessey JV. Consistent reversible elevations of serum creatinine levels in severe hypothyroidism. Arch Intern Med . 1999;159(1):79–82.
  9. Chou KM, Chiu SY, Chen CH, Yang NI, Huang BY, Sun CY. Correlation of clinical changes with regard to thyroxine replacement therapy in hypothyroid patients—focusing on the change of renal function. Kidney Blood Press Res . 2011;34(5):365–372.
  10. Asvold BO, Bjoro T, Vatten LJ. Association of thyroid function with estimated glomerular filtration rate in a population-based study. The HUNT Study. Eur J Endocrinol . 2011;164(1):101–105.
  11. Lindeman RD, Tobin J, Shock NW. Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc . 1985;33(4):278–285.
  12. Li Z, Wang Y. Chronic Kidney Disease Caused by Hypothyroidism. J Integr Nephrol Androl 2015;2:93-5.
  13. Available at https://www.nature.com/articles/s41598-018-19693-4.
  14. Chonchol, M. et al. Prevalence of subclinical hypothyroidism in patients with chronic kidney disease. Clin J Am Soc Nephrol. 3, 1296–300 (2008).
  15. Asvold, B. O., Bjoro, T. & Vatten, L. J. Association of thyroid function with estimated glomerular filtration rate in a population-based study: the HUNT study. Eur J Endocrinol. 164, 101–5 (2011).
  16. Lo, J. C., Chertow, G. M., Go, A. S. & Hsu, C. Y. Increased prevalence of subclinical and clinical hypothyroidism in persons with chronic kidney disease. Kidney Int. 67, 1047–52 (2005).
  17. Kaptein, E. M. et al. The thyroid in end-stage renal disease. Medicine (Baltimore). 67, 187–97 (1988).
  18. Kaptein, E. M., Feinstein, E. I., Nicoloff, J. T. & Massry, S. G. Serum reverse triiodothyronine and thyroxine kinetics in patients with chronic renal failure. J Clin Endocrinol Metab. 57, 181–9 (1983).
  19. Wartofsky, L. & Burman, K. D. Alterations in thyroid function in patients with systemic illness: the ‘euthyroid sick syndrome’. Endocrine Reviews. 3, 164–217 (1982).
  20. Freeston, J. & Gough, A. Reversible myopathy and renal impairment. J R Soc Med. 97, 124–125 (2004).
  21. Makino, Y. et al. Exacerbation of renal failure due to hypothyroidism in a patient with ischemic nephropathy. Nephron. 84, 267–9 (2008).
  22. Mooraki, A., Broumand, B., Neekdoost, F., Amirmokri, P. & Bastani, B. Reversible acute renal failure associated with hypothyroidism: report of four cases with a brief review of literature. Nephrology (Carlton). 8, 57–60 (2003).
  23. Andrew, C. & Joanne, E. T. Renal impairment resulting from hypothyroidism. NDT Plus 1, 440–441 (2008).
  24. Liu, K. L. et al. Vascular function of the mesenteric artery isolated from thyroid hormone receptor-α knockout mice. J Vasc Res. 51, 350–9 (2014).
  25. Chuang, M. H. et al. Abnormal Thyroid-Stimulating Hormone and Chronic Kidney Disease in Elderly Adults in Taipei City. J Am Geriatr Soc. 64, 1267–73 (2016).
  26. Feinstein, E. I., Kaptein, E. M., Nicoloff, J. T. & Massry, S. G. Thyroid function in patients with nephrotic syndrome and normal renal function. Am J Nephrol. 2, 70–6 (1982).
  27. Gilles, R. et al. Thyroid function in patients with proteinuria. Neth J Med. 66, 483–5 (2008).
  28. Kreisman, S. H. & Hennessey, J. V. Consistent reversible elevations of serum creatinine levels in severe hypothyroidism. Arch Intern Med. 159, 79–82 (1999).
  29. Montenegro, J. et al. Changes in renal function in primary hypothyroidism Am J Kidney Dis. 27, 195–8.10 (1996).
  30. den Hollander, J. G., Wulkan, R. W., Mantel, M. J. & Berghout, A. Correlation between severity of thyroid dysfunction and renal function. Clin Endocrinol (Oxf). 62, 423–7 (2005).
  31. Mariani LH. Berns JS. The renal manifestations of thyroid disease. J Am Soc Nephrol. 2012;23:22–26.
  32. Iglesias P. Diez JJ. Thyroid dysfunction and kidney disease. Eur J Endocrinol. 2009;160:503–515.
  33. Shin, D. H. et al. Thyroid Hormone Replacement Therapy Attenuates the Decline of Renal Function in Chronic Kidney Disease Patients with Subclinical Hypothyroidism. Thyroid. 23, 654–661 (2013).
  34. Shin, D. H. et al. Preservation of renal function by thyroid hormone replacement therapy in chronic kidney disease patients with subclinical hypothyroidism. J Clin Endocrinol Metab. 97, 2732–40 (2012).
  35. Wheatley, T. & Edwards, O. M. Mild hypothyroidism and oedema: evidence for increased capillary permeability to protein. Clin Endocrinol (Oxf). 18, 627–35 (1983).
  36. Paydas, S. & Gokel, Y. Different renal pathologies associated with hypothyroidism. Ren Fail. 24, 595–600 (2002).
  37. Valentin, M. et al. Membranoproliferative glomerulonephritis associated with autoimmune thyroiditis. Nefrologia. 24(Suppl 3), 43–8 (2004).
  38. Iwazu, Y. et al. A case of minimal change nephrotic syndrome with acute renal failure complicating Hashimotoas disease. Clin Nephrol. 69, 47–52 (2008).
  39. Trouillier, S. et al. Nephrotic syndrome: don’t forget to search for hypothyroidism. Rev Med Interne. 29, 139–44 (2008).
  40. Hajji, R. et al. Transient Proteinuria: An Unusual Complication of Hypothyroidism. American Journal of Medical Case Reports. 2, 237–239 (2014).
  41. Shin DH, Lee MJ, Lee HS, et al. Thyroid Hormone Replacement Therapy Attenuates the Decline of Renal Function in Chronic Kidney Disease Patients with Subclinical Hypothyroidism. Thyroid. 2013;23(6):654-661. doi:10.1089/thy.2012.0475.
  42. Freeston J. Gough A. Reversible myopathy and renal impairment. J R Soc Med. 2004;97:124–125.
  43. Makino Y. Fujii T. Kuroda S. Inenaga T. Kawano Y. Takishita S. Exacerbation of renal failure due to hypothyroidism in a patient with ischemic nephropathy. Nephron. 2000;84:267–269.
  44. Mooraki A. Broumand B. Neekdoost F. Amirmokri P. Bastani B. Reversible acute renal failure associated with hypothyroidism: report of four cases with a brief review of literature. Nephrology (Carlton) 2003;8:57–60.
  45. den Hollander JG. Wulkan RW. Mantel MJ. Berghout A. Correlation between severity of thyroid dysfunction and renal function. Clin Endocrinol (Oxf) 2005;62:423–427.
  46. Shin DH. Lee MJ. Kim SJ. Oh HJ. Kim HR. Han JH. Koo HM. Doh FM. Park JT. Han SH. Yoo TH. Kang SW. Preservation of renal function by thyroid hormone replacement therapy in chronic kidney disease patients with subclinical hypothyroidism. J Clin Endocrinol Metab. 2012;97:2732–2740.
  47. Lu Y, Guo H, Liu D, Zhao Z. Preservation of renal function by thyroid hormone replacement in elderly persons with subclinical hypothyroidism. Archives of Medical Science : AMS. 2016;12(4):772-777. doi:10.5114/aoms.2016.60965.
  48. Kimmel M, Braun N, Alscher MD. Influence of thyroid function on different kidney function tests. Kidney Blood Press Res 2012;35:9-17.

 

  1. McDermott MT, Ridgway EC. Subclinical hypothyroidism is mild thyroid failure and should be treated. J Clin Endocrinol Metab 2001;86:4585-90.
  2. Lu Y, Guo H, Liu D, Zhao Z. Preservation of renal function by thyroid hormone replacement in elderly persons with subclinical hypothyroidism. Arch Med Sci 2016;12:772-7.
  3. Available at https://www.tandfonline.com/doi/full/10.3109/0886022X.2013.824381.
  4. Hataya, Y., S. Igarashi, T. Yamashita and Y. Komatsu, 2012. Thyroid hormone replacement therapy for primary hypothyroidism leads to significant improvement of renal function in chronic kidney disease patients. Clin. Exp. Nephrol., 10.1007/s10157-012-0727-y.
  5. Montenegro J, González O, Saracho R, Aguirre R, González O, Martínez I. Changes in renal function in primary hypothyroidism. Am J Kidney Dis. 1996;27(2):195–198.
  6. Nikolaeva AV, Pimenov LT. Lipid metabolism and functional status of the kidney in hypothyroid patients depending on the phase of disease. Ter Arkh. 2002;74(10):20–23.
  7. Capasso G, De Tommaso G, Pica A, et al. Effects of thyroid hormones on heart and kidney functions. Miner Electrolyte Metab. 1999;25(1–2):56–64.
  8. del-Río Camacho G, Tapia Ceballos L, Picazo Angelín B, Ruiz Moreno JA, Hortas Nieto ML, Romero González J. Renal failure and acquired hypothyroidism. Pediatr Nephrol. 2003;18(3):290–292.
  9. den Hollander JG, Wulkan RW, Mantel MJ, Berghout A. Correlation between severity of thyroid dysfunction and renal function. Clin Endocrinol (Oxf). 2005;62:423–427.
  10. van Welsem ME, Lobatto S. Treatment of severe hypothyroidism in a patient with progressive renal failure leads to significant improvement of renal function. Clin Nephrol. 2007;67(6):391–393.
  11. Hataya Y, Igarashi S, Yamashita T, Komatsu Y. Thyroid hormone replacement therapy for primary hypothyroidism leads to significant improvement of renal function in chronic kidney disease patients. Clin Exp Nephrol. 2012 Nov 17.
  12. Ota K, Kimura T, Sakurada T, et al. Effects of an acute water load on plasma ANP and AVP, and renal water handling in hypothyroidism: comparison of before and after L-thyroxine treatment. Endocr J. 1994;41(1):99-105.
  13. Available at http://www.e-ijas.org/article.asp?issn=WKMP-0143;year=2016;volume=1;issue=1;spage=39;epage=41;aulast=Jabari.
Share -

Call 800-277-4041 for a Free Consultation

What to expect during your consultation:
  • Usually takes 15-30 minutes
  • Completely confidential
  • No obligation to purchase anything
  • We will discuss your symptoms along with your health and fitness goals
  • Free post-consult access for any additional questions you may have
Contact Us Page
Sending

Genemedics® Health Institute is a global premier institute dedicated to revolutionizing health and medicine through healthy lifestyle education, guidance and accountability in harmony with functional medicine. Our physician-supervised health programs are personally customized to help you reach your health and fitness goals while looking and feeling better than ever.