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July 3, 2026Cleveland Clinic Journal of MedicineOpen Access

Treatment-refractory hypothyroidism: Don’t just increase the dose

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Authors

NSNabil William G SweisNorthwestern UniversityJMJennifer S. MammenJohns Hopkins University

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Overview

Randomized trial finds alternatives to levothyroxine enhance outcomes in treatment-refractory hypothyroidism, suggesting important diagnostic steps.

Key Points

  • This research aims to identify factors causing treatment-refractory hypothyroidism and explore diagnostic approaches and alternative treatments.
  • Conducted a stepwise diagnostic approach involving detailed history and gastrointestinal evaluations.
  • Considered assay interference and confounding conditions in assessments.
  • Explored alternative levothyroxine formulations beyond oral tablets.
  • Identified multiple causes of treatment-refractory hypothyroidism including nonadherence and gastrointestinal disorders.
  • Demonstrated that alternative levothyroxine formulations may be beneficial in select cases.

Cite This Study

Sweis et al. (2026) studied this question.

synapsesocial.com/papers/6a4754965c29257aa257a18fhttps://doi.org/10.3949/ccjm.93a.25100
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