![]() Subclinical hypothyroidism has been reviewed in a previous Lancet Seminar 1 and is therefore not the focus here. Mild or subclinical hypothyroidism, which is commonly regarded as a sign of early thyroid failure, is defined by TSH concentrations above the reference range and free thyroxine concentrations within the normal range. Overt or clinical primary hypothyroidism is defined as thyroid-stimulating hormone (TSH) concentrations above the reference range and free thyroxine concentrations below the reference range. Because of the large variation in clinical presentation and general absence of symptom specificity, the definition of hypothyroidism is pre-dominantly biochemical. ![]() If untreated, it can lead to serious adverse health effects and ultimately death. Hypothyroidism refers to the common pathological condition of thyroid hormone deficiency. In this Seminar, we discuss the epidemiology, causes, and symptoms of hypothyroidism summarise evidence on diagnosis, long-term risk, treatment, and management and highlight future directions for research. However, a substantial proportion of patients who reach biochemical treatment targets have persistent complaints. The standard treatment is thyroid hormone replacement therapy with levothyroxine. The most common symptoms in adults are fatigue, lethargy, cold intolerance, weight gain, constipation, change in voice, and dry skin, but clinical presentation can differ with age and sex, among other factors. Clinical manifestations of hypothyroidism range from life threatening to no signs or symptoms. The definition of hypothyroidism is based on statistical reference ranges of the relevant biochemical parameters and is increasingly a matter of debate. Hypothyroidism is a common condition of thyroid hormone deficiency, which is readily diagnosed and managed but potentially fatal in severe cases if untreated.
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