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Medically not yet explained symptoms in hypothyroidism

Nature Reviews Endocrinology volume 20, pages 685–693 (2024)Cite this article

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Abstract

Persistent symptoms are common in the general population and even more so in people with hypothyroidism. When symptoms are unexplained and brought to medical attention, they can be referred to as medically not yet explained symptoms (MNYES), a term preferred to other descriptors by patients, care-givers and experts. MNYES might be neglected by endocrinologists or misattributed to hypothyroidism. Awareness of MNYES could open up more effective and less harmful interventions for patients who present to endocrinologists with unexplained symptoms than costly over-investigations and over-treatment with thyroid hormones (such as levothyroxine and liothyronine). The role of the endocrinologist is to recognize and acknowledge that MNYES could be underlying a patient’s presentation, to communicate effectively with the patient and others involved in the patient’s care, to apply a ‘two-track approach’ in management by paying equal attention to physical and psychosocial contributors, and to collaborate with other relevant health professionals. Categorization of patients into levels of risk for symptom deterioration helps in selecting suitable therapies. Effective management of MNYES demands time, training, expertise and resources.

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Fig. 1: Results of a survey on persistent symptoms in patients with hypothyroidism.
Fig. 2: A survey of clinicians on the causes of persistent symptoms in inidividuals with hypothyroidism.

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References

  1. Peterson, S. J. et al. An online survey of hypothyroid patients demonstrates prominent dissatisfaction. Thyroid 28, 707–721 (2018).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Hegedüs, L. et al. Primary hypothyroidism and quality of life. Nat. Rev. Endocrinol. 18, 230–242 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  3. Perros, P. et al. The enigma of persistent symptoms in hypothyroid patients treated with levothyroxine: a narrative review. Clin. Endocrinol. 98, 461–468 (2023).

    Article  Google Scholar 

  4. Jonklaas, J. et al. Evidence-based use of levothyroxine/liothyronine combinations in treating hypothyroidism: a consensus document. Eur. Thyroid. J. 10, 10–38 (2021).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Premawardhana, L. D. et al. Designing a combined liothyronine (LT3), L-thyroxine (LT4) trial in symptomatic hypothyroid subjects on LT4 – the importance of patient selection, choice of LT3 and trial design. Front. Endocrinol. 14, 1282608 (2023).

    Article  Google Scholar 

  6. Jonklaas, J. et al. Evidence-based use of levothyroxine/liothyronine combinations in treating hypothyroidism: a consensus document. Thyroid 31, 156–182 (2021).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Taylor, P. N. et al. Falling threshold for treatment of borderline elevated thyrotropin levels – balancing benefits and risks: evidence from a large community-based study. JAMA Intern. Med. 174, 32–39 (2014).

    Article  CAS  PubMed  Google Scholar 

  8. Brito, J. P. et al. Levothyroxine use in the United States, 2008-2018. JAMA Intern. Med. 181, 1402–1405 (2021).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Medici, B. B. et al. Changes in prescription routines for treating hypothyroidism between 2001 and 2015: an observational study of 929,684 primary care patients in copenhagen. Thyroid 29, 910–919 (2019).

    Article  CAS  PubMed  Google Scholar 

  10. Carle, A. et al. Does subclinical hypothyroidism add any symptoms? Evidence from a Danish population-based study. Am. J. Med. 134, 1115–1126.e1 (2021).

    Article  CAS  PubMed  Google Scholar 

  11. Hansen, P. S., Brix, T. H., Sorensen, T. I., Kyvik, K. O. & Hegedüs, L. Major genetic influence on the regulation of the pituitary–thyroid axis: a study of healthy Danish twins. J. Clin. Endocrinol. Metab. 89, 1181–1187 (2004).

    Article  CAS  PubMed  Google Scholar 

  12. Razvi, S. Thyroid-function reference ranges in the diagnosis of thyroid dysfunction in adults. Nat. Rev. Endocrinol. 20, 253–254 (2024).

    Article  CAS  PubMed  Google Scholar 

  13. Thvilum, M. et al. Type and extent of somatic morbidity before and after the diagnosis of hypothyroidism. a nationwide register study. PLoS ONE 8, e75789 (2013).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Thvilum, M. et al. Increased psychiatric morbidity before and after the diagnosis of hypothyroidism: a nationwide register study. Thyroid 24, 802–808 (2014).

    Article  PubMed  Google Scholar 

  15. Thvilum, M., Brandt, F., Brix, T. H. & Hegedüs, L. Hypothyroidism is a predictor of disability pension and loss of labor market income: a Danish register-based study. J. Clin. Endocrinol. Metab. 99, 3129–3135 (2014).

    Article  CAS  PubMed  Google Scholar 

  16. Patel, M. et al. Persistent physical symptoms reduction intervention: a system change and evaluation (PRINCE)-integrated GP care for persistent physical symptoms: protocol for a feasibility and cluster randomised waiting list, controlled trial. BMJ Open. 9, e025513 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  17. van der Feltz-Cornelis, C. M. et al. Identifying the top research priorities in medically not yet explained symptoms (MNYES): a James Lind Alliance priority setting partnership. BMJ Open. 12, e061263 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  18. Henningsen, P., Zipfel, S. & Herzog, W. Management of functional somatic syndromes. Lancet 369, 946–955 (2007).

    Article  PubMed  Google Scholar 

  19. Lipowski, Z. J. Somatization: the concept and its clinical application. Am. J. Psychiatry 145, 1358–1368 (1988).

    Article  CAS  PubMed  Google Scholar 

  20. van der Feltz-Cornelis, C. M. & van Dyck, R. The notion of somatization: an artefact of the conceptualization of body and mind. Psychother. Psychosom. 66, 117–127 (1997).

    Article  PubMed  Google Scholar 

  21. van Eck van der Sluijs, J. et al. Medically unexplained and explained physical symptoms in the general population: association with prevalent and incident mental disorders. PLoS ONE 10, e0123274 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  22. Swanson, L. M., Hamilton, J. C. & Feldman, M. D. Physician-based estimates of medically unexplained symptoms: a comparison of four case definitions. Fam. Pract. 27, 487–493 (2010).

    Article  PubMed  Google Scholar 

  23. Korber, S., Frieser, D., Steinbrecher, N. & Hiller, W. Classification characteristics of the Patient Health Questionnaire-15 for screening somatoform disorders in a primary care setting. J. Psychosom. Res. 71, 142–147 (2011).

    Article  PubMed  Google Scholar 

  24. Gaille, M. “Patient’s lived experience”: new insights from the “scene” of deep-brain stimulation medical care. Med. Health Care Philos. 22, 339–342 (2019).

    Article  PubMed  Google Scholar 

  25. Michaelsson, L. F. et al. Treating hypothyroidism with thyroxine/triiodothyronine combination therapy in Denmark: following guidelines or following trends? Eur. Thyroid. J. 4, 174–180 (2015).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Mitchell, A. L., Hegedüs, L., Zarkovic, M., Hickey, J. L. & Perros, P. Patient satisfaction and quality of life in hypothyroidism: an online survey by the British Thyroid Foundation. Clin. Endocrinol. 94, 513–520 (2021).

    Article  CAS  Google Scholar 

  27. Perros, P. & Hegedüs, L. Enhanced well-being associated with thyrotoxicosis: a neglected effect of thyroid hormones? Int. J. Endocrinol. Metab. 20, e127230 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  28. Perros, P. et al. Hypothyroidism and somatization: results from e-mode patient self-assessment of thyroid therapy, a cross-sectional, international online patient survey. Thyroid 33, 927–939 (2023).

    Article  PubMed  Google Scholar 

  29. Perros, P. et al. Hypothyroidism and type D personality: results from E-MPATHY, a cross-sectional International online patient survey. J. Clin. Endocrinol. Metab. https://doi.org/10.1210/clinem/dgae140 (2024).

  30. Negro, R. et al. Use of thyroid hormones in hypothyroid and euthyroid patients; the 2019 Italian Survey. Eur. Thyroid. J. 9, 25–31 (2020).

    Article  CAS  PubMed  Google Scholar 

  31. Borissova, A.-M. et al. Use of thyroid hormones in hypothyroid and euthyroid patients: a THESIS questionnaire survey of Bulgarian physicians. Endocrinologia 25, 229–309 (2020).

    Google Scholar 

  32. Niculescu, D. A. et al. Use of thyroid hormones in hypothyroid and euthyroid patients: a Thesis* questionnaire survey of Romanian physicians *Thesis: treatment of hypothyroidism in Europe by specialists: an international survey. Acta Endocrinol. 16, 462–469 (2020).

    CAS  Google Scholar 

  33. Riis, K. R. et al. Use of thyroid hormones in hypothyroid and euthyroid patients: A 2020 THESIS questionnaire survey of members of the Danish Endocrine Society. J. Endocrinol. Invest. 44, 2435–2444 (2021).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Bednarczuk, T. et al. Use of thyroid hormones in hypothyroid and euthyroid patients: a THESIS* questionnaire survey of Polish physicians. *THESIS: treatment of hypothyroidism in Europe by specialists: an international survey. Endokrynol. Pol. 72, 357–365 (2021).

    Article  PubMed  Google Scholar 

  35. Galofre, J. C. et al. Use of thyroid hormone in hypothyroid patients and euthyroid subjects in Spain: a THESIS* questionnaire survey. Endocrinol. Diabetes Nutr. 69, 520–529 (2022).

    Article  Google Scholar 

  36. Metso, S. et al. Use of thyroid hormones in the treatment of hypothyroidism: Thesis questionnaire survey for Finnish specialists. Finnish Med. J. 48, 2885–2889 (2021).

    Google Scholar 

  37. Buffet, C. et al. Real-life practice of thyroid hormone use in hypothyroid and euthyroid patients: a detailed view from the THESIS questionnaire survey in France. Ann. Endocrinol. 83, 27–34 (2022).

    Article  Google Scholar 

  38. Shepelkevich, A. P. et al. Features of the use of synthetic analogues of thyroid hormones: small a, Cyrillic 2020 THESIS* questionnaire survey of members of the Belarusian Public Medical Association of Endocrinology and Metabolism [Russian]. Probl. Endokrinol. 68, 18–26 (2021).

    Article  CAS  Google Scholar 

  39. Paschou, S. A. et al. Use of thyroid hormones in hypothyroid and euthyroid patients: a 2020 THESIS questionnaire survey of members of the Hellenic Endocrine Society. Hormones 21, 103–111 (2022).

    Article  PubMed  Google Scholar 

  40. Burlacu, M. C. et al. Use of thyroid hormones in hypothyroid and euthyroid patients: a THESIS* survey of Belgian specialists *THESIS: treatment of hypothyroidism in Europe by specialists: an international survey. Thyroid. Res. 15, 3 (2022).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Puga, F. et al. Use of thyroid hormones in hypothyroid and euthyroid patients: a THESIS questionnaire survey of Portuguese endocrinologists. Rev. Portuguesa de. Endocrinologia, Diabetes e Metabolismo 17, 9–18 (2022).

    Google Scholar 

  42. Berta, E. et al. Use of thyroid hormones in hypothyroid and euthyroid patients. A THESIS questionnaire survey of Hungarian physicians. Orvosi Hetil. 163, 463–472 (2022).

    Article  Google Scholar 

  43. Jiskra, J. et al. Use of thyroid hormones in hypothyroid and euthyroid patients: a 2020 THESIS questionnaire survey of members of the Czech Society of Endocrinology. BMC Endocr. Disord. 22, 117 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  44. Vardarli, I. et al. A questionnaire survey of german thyroidologists on the use of thyroid hormones in hypothyroid and euthyroid patients: the THESIS (Treatment of Hypothyroidism in Europe by Specialists: an International Survey) collaborative. Exp. Clin. Endocrinol. Diabetes 130, 577–586 (2022).

    Article  CAS  PubMed  Google Scholar 

  45. Ayvaz, G. et al. The use of thyroid hormones in hypothyroid and euthyroid patients: a THESIS* questionnaire survey of Turkish physicians. Turk. J. Endocrinol. Metab. 26, 85–91 (2022).

    Article  Google Scholar 

  46. Younes, Y. R. et al. Use of thyroid hormones in hypothyroid and euthyroid patients: a THESIS questionnaire survey of UK endocrinologists. Clin. Endocrinol. 98, 238–248 (2023).

    Article  CAS  Google Scholar 

  47. Mustafa, M. et al. Use of thyroid hormones in hypothyroid and euthyroid patients: a THESIS questionnaire survey of members of the Irish Endocrine Society. Ir. J. Med. Sci. 192, 2179–2187 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  48. Beleslin, B. N. et al. Use of thyroid hormones in hypothyroid and euthyroid patients: a THESIS questionnaire survey of Serbian physicians. Srpski Arh. za celokupno lekarstvo 150, 667–674 (2022).

    Article  Google Scholar 

  49. Planck, T. et al. Use of thyroid hormones in hypothyroid and euthyroid patients: a 2020 THESIS questionnaire survey of members of the Swedish Endocrine Society. Front. Endocrinol. 12, 795111 (2021).

    Article  Google Scholar 

  50. Zarkovic, M. et al. Characteristics of specialists treating hypothyroid patients: the “THESIS” collaborative. Front. Endocrinol. 14, 1225202 (2023).

    Article  Google Scholar 

  51. Attanasio, R. et al. Patients’ persistent symptoms, clinician demographics and geo-economic factors are associated with choice of therapy for hypothyroidism by European thyroid specialists: the THESIS Collaboration. Thyroid 34, 429–441 (2024).

    PubMed  Google Scholar 

  52. Cassemiro, J. F. et al. Use of thyroid hormones in hypothyroid and euthyroid patients: a 2022 THESIS questionnaire survey of members of the Latin American Thyroid Society (LATS). Thyroid. Res. 16, 40 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  53. Lafontaine, N. et al. Use of thyroid hormones in hypothyroid and euthyroid patients: a survey of members of the Endocrine Society of Australia. Clin. Endocrinol. 100, 477–485 (2024).

    Article  Google Scholar 

  54. Jonklaas, J. et al. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association task force on thyroid hormone replacement. Thyroid 24, 1670–1751 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  55. National Insitute for Health and Care Excellence. Thyroid disease: assessment and management. NICE guideline [NG145]. NICE www.nice.org.uk/guidance/ng145 (2023).

  56. Kroenke, K. et al. Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment. Arch. Fam. Med. 3, 774–779 (1994).

    Article  CAS  PubMed  Google Scholar 

  57. Kroenke, K., Jackson, J. L. & Chamberlin, J. Depressive and anxiety disorders in patients presenting with physical complaints: clinical predictors and outcome. Am. J. Med. 103, 339–347 (1997).

    Article  CAS  PubMed  Google Scholar 

  58. van der Leeuw, G. et al. The association between somatization and disability in primary care patients. J. Psychosom. Res. 79, 117–122 (2015).

    Article  PubMed  Google Scholar 

  59. American Psychiatric Association. The Diagnostic and Statistical Manual of Mental Disorders 5th edn DSM-5 (American Psychiatric Association, 2013).

  60. World Health Organization. ICD-11: International Classification of Diseases 11th Revision. WHO https://icd.who.int/browse11 (2020).

  61. Reid, S., Wessely, S., Crayford, T. & Hotopf, M. Frequent attenders with medically unexplained symptoms: service use and costs in secondary care. Br. J. Psychiatry 180, 248–253 (2002).

    Article  PubMed  Google Scholar 

  62. Nimnuan, C., Hotopf, M. & Wessely, S. Medically unexplained symptoms: an epidemiological study in seven specialities. J. Psychosom. Res. 51, 361–367 (2001).

    Article  CAS  PubMed  Google Scholar 

  63. Kellner, R. & Sheffield, B. F. The one-week prevalence of symptoms in neurotic patients and normals. Am. J. Psychiatry 130, 102–105 (1973).

    Article  CAS  PubMed  Google Scholar 

  64. Klemenz, B. Doctors’ ongoing education, empathy, and continuous emotional and psychological support for patients might help to deal with their medically unexplained symptoms. Br. J. Gen. Pract. 69, 332–333 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  65. Volcheck, M. M., Graham, S. M., Fleming, K. C., Mohabbat, A. B. & Luedtke, C. A. Central sensitization, chronic pain, and other symptoms: better understanding, better management. Cleve Clin. J. Med. 90, 245–254 (2023).

    Article  PubMed  Google Scholar 

  66. Jansen, H. I., Boelen, A., Heijboer, A. C., Bruinstroop, E. & Fliers, E. Hypothyroidism: the difficulty in attributing symptoms to their underlying cause. Front. Endocrinol. 14, 1130661 (2023).

    Article  Google Scholar 

  67. Panicker, V. et al. A paradoxical difference in relationship between anxiety, depression and thyroid function in subjects on and not on T4: findings from the HUNT study. Clin. Endocrinol. 71, 574–580 (2009).

    Article  Google Scholar 

  68. Nimnuan, C., Hotopf, M. & Wessely, S. Medically unexplained symptoms: how often and why are they missed? QJM 93, 21–28 (2000).

    Article  CAS  PubMed  Google Scholar 

  69. van der Feltz-Cornelis, C. M., van Oppen, P., Ader, H. J. & van Dyck, R. Randomised controlled trial of a collaborative care model with psychiatric consultation for persistent medically unexplained symptoms in general practice. Psychother. Psychosom. 75, 282–289 (2006).

    Article  PubMed  Google Scholar 

  70. Shen, Y. et al. Association of thyroid dysfunction with suicide attempts in first-episode and drug naive patients with major depressive disorder. J. Affect. Disord. 259, 180–185 (2019).

    Article  CAS  PubMed  Google Scholar 

  71. Heiberg Brix, T., Ferlov-Schwensen, C., Thvilum, M. & Hegedüs, L. Death by unnatural causes, mainly suicide, is increased in patients with Hashimoto’s thyroiditis. A nationwide Danish Register study. Endocrine 65, 616–622 (2019).

    Article  CAS  PubMed  Google Scholar 

  72. Zhao, S., Chen, Z., Wang, X., Yao, Z. & Lu, Q. Increased prevalence of subclinical hypothyroidism in female hospitalized patients with depression. Endocrine 72, 479–485 (2021).

    Article  CAS  PubMed  Google Scholar 

  73. Rief, W. et al. Core outcome domains for clinical trials on somatic symptom disorder, bodily distress disorder, and functional somatic syndromes: European Network on Somatic Symptom Disorders recommendations. Psychosom. Med. 79, 1008–1015 (2017).

    Article  PubMed  Google Scholar 

  74. Kurlansik, S. L. & Maffei, M. S. Somatic symptom disorder. Am. Fam. Physician 93, 49–54 (2016).

    PubMed  Google Scholar 

  75. van der Feltz-Cornelis, C. M., Hoedeman, R., Keuter, E. J. & Swinkels, J. A. Presentation of the Multidisciplinary Guideline Medically Unexplained Physical Symptoms (MUPS) and Somatoform Disorder in the Netherlands: disease management according to risk profiles. J. Psychosom. Res. 72, 168–169 (2012).

    Article  PubMed  Google Scholar 

  76. van der Feltz-Cornelis, C. M., Van Os, T. W., Van Marwijk, H. W. & Leentjens, A. F. Effect of psychiatric consultation models in primary care. A systematic review and meta-analysis of randomized clinical trials. J. Psychosom. Res. 68, 521–533 (2010).

    Article  PubMed  Google Scholar 

  77. Perros, P. et al. The impact of hypothyroidism on satisfaction with care and treatment and everyday living: results from E-mode patient self-assessment of thyroid therapy, a cross-sectional, international online patient survey. Thyroid 32, 1158–1168 (2022).

    PubMed  Google Scholar 

  78. Hahn, S. R. et al. The difficult patient: prevalence, psychopathology, and functional impairment. J. Gen. Intern. Med. 11, 1–8 (1996).

    Article  CAS  PubMed  Google Scholar 

  79. Howick, J., Bizzari, V. & Dambha-Miller, H. Therapeutic empathy: what it is and what it isn’t. J. R. Soc. Med. 111, 233–236 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  80. Leentjens, A. F., Boenink, A. D. & van der Feltz-Cornelis, C. M. Can we increase adherence to treatment recommendations of the consultation psychiatrist working in a general hospital? A systematic review. J. Psychosom. Res. 68, 303–309 (2010).

    Article  PubMed  Google Scholar 

  81. Salinsky, J. Balint groups and the Balint method. The Balint Society balint.co.uk/about/the-balint-method/#:~:Text=The%20Balint%20group%20is%20a,of%20both%20doctor%20and%20patient (2003).

  82. van der Feltz-Cornelis, C. M. Economical framework of psychiatric care (ed. Helmchen, H. and Sartorius, N.). In Ethics in psychiatry: European contributions (Springer, Dordrecht, 2010).

  83. Esfandiari, N. H., Reyes-Gastelum, D., Hawley, S. T., Haymart, M. R. & Papaleontiou, M. Patient requests for tests and treatments impact physician management of hypothyroidism. Thyroid 29, 1536–1544 (2019).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  84. Lillevang-Johansen, M., Abrahamsen, B., Jørgensen, H. L., Brix, T. H. & Hegedüs, L. Over- and under-treatment of hypothyroidism is associated with excess mortality: a register-based cohort study. Thyroid 28, 566–574 (2018).

    Article  CAS  PubMed  Google Scholar 

  85. Wiersinga, W. M., Duntas, L., Fadeyev, V., Nygaard, B. & Vanderpump, M. P. 2012 ETA guidelines: the use of L-T4 + L-T3 in the treatment of hypothyroidism. Eur. Thyroid. J. 1, 55–71 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  86. Biondi, B., Celi, F. S. & McAninch, E. A. Critical approach to hypothyroid patients with persistent symptoms. J. Clin. Endocrinol. Metab. 108, 2708–2716 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

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Author notes

  1. These authors contributed equally: Laszlo Hegedüs, Christina M. Van Der Feltz-Cornelis.

Authors and Affiliations

  1. Department of Endocrinology, Odense University Hospital, Odense, Denmark

    Laszlo Hegedüs

  2. Department of Health Sciences, HYMS, University of York, York, UK

    Christina M. Van Der Feltz-Cornelis

  3. Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano, Rome, Italy

    Enrico Papini

  4. Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

    Endre V. Nagy

  5. Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK

    Anthony P. Weetman

  6. Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK

    Petros Perros

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Correspondence to Laszlo Hegedüs.

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L.H., P.P., E.V.N. and E.P. have received honoraria from IBSA Biochimique SA. L.H. reports receiving honoraria from Merck and Berlin-Chemie. The other authors declare no competing interests.

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Hegedüs, L., Van Der Feltz-Cornelis, C.M., Papini, E. et al. Medically not yet explained symptoms in hypothyroidism. Nat Rev Endocrinol 20, 685–693 (2024). https://doi.org/10.1038/s41574-024-01022-7

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