Seyed Mohammad Aria , Maryam Zahedi , Fatemeh Mohmmadzade , Alireza Seyedi Niaki , Somayeh Ghorbai ,
Volume 27, Issue 4 (12-2025)
Abstract
Background and Objective: Hypothyroidism is a clinical syndrome resulting from a deficiency in thyroid hormone production. Despite achieving normalized thyroid-stimulating hormone (TSH) levels through levothyroxine (LT4) therapy, many patients continue to experience residual symptoms. This persistence raises questions regarding the adequacy of standard monotherapy and suggests that alternative treatments, such as combination therapy (LT4 and liothyronine [LT3]), may be more effective for certain individuals. This study was conducted to determine the prevalence of residual symptoms after TSH normalization in patients with hypothyroidism in Gorgan, Iran.
Methods: This descriptive-analytical study was conducted on 200 patients (193 females, 7 males; mean age = 41.81±12.25 years) with a confirmed diagnosis of hypothyroidism who were under regular treatment and had normalized TSH. Subjects were recruited from those referring to an endocrinology subspecialty clinic in 2022 in Gorgan. Eligible participants were asked to complete a checklist assessing common symptoms of hypothyroidism, including fatigue, dry skin, weight gain, cold intolerance, constipation, muscle cramps, facial puffiness, and hair loss. Paraclinical data, including TSH and thyroid peroxidase antibody (anti-TPO) levels, were also collected.
Results: The most prevalent residual symptoms of hypothyroidism were fatigue (74.2%), cold intolerance (73.7%), and dry skin (73.2%). A statistically significant correlation was found between body mass index (BMI) and dry skin (P<0.05). However, no significant correlation was observed between TSH levels and the persistence of symptoms.
Conclusion: Despite TSH normalization, symptoms of hypothyroidism-including fatigue, cold intolerance, and dry skin-persist in more than 70% of cases.
