What is the prognosis of hypothyroidism?

Updated: Mar 03, 2021
  • Author: Philip R Orlander, MD, FACP; Chief Editor: George T Griffing, MD  more...
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Answer

Undertreatment of hypothyroidism leads to disease progression, with gradual worsening of symptoms and further metabolic derangements. Ultimately, untreated hypothyroidism can cause profound coma or even death. Untreated hypothyroidism in infants can cause irreversible mental retardation.

A study by Thvilum et al suggested that hypothyroidism is associated with the development of dementia. The report indicated that each 6-month period of elevated TSH increases an individual’s risk of dementia by 12%. [32]

In most patients, fortunately, thyroid hormone treatment reverses the signs and symptoms of hypothyroidism. With treatment, other secondarily affected laboratory values (eg, circulating lipid levels and elevated prolactin levels) should improve.

Using disease-specific (ThyPRO questionnaire) and generic (36-item Short Form Health Survey [SF-36]) measures of health-related quality of life (HRQL), Winther et al discovered that levothyroxine treatment resulted in improvement in some, but not all, aspects of HRQL in patients with hypothyroidism resulting from autoimmune thyroiditis. This included significant improvements in nine of 13 ThyPRO scales after 6 weeks of therapy. [33]

A study by Chang et al suggested that subclinical and overt hypothyroidism are linked to reduced renal function, with subclinical hypothyroidism raising the risk of chronic kidney disease (estimated glomerular filtration rate of below 60 mL/min/1.73m2) by 2.03-fold, and overt hypothyroidism increasing the risk by 7.68-fold. The increased risk remained significant even after other potential risk factors for chronic kidney disease were taken into account. The study also indicated, however, that subclinical and overt hypothyroidism have a lesser effect on proteinuria risk. [34]

In addition, a prospective observational study by Tsuda et al indicated that in patients with chronic kidney disease, subclinical hypothyroidism is an independent risk factor for poor outcome. The report found, for example, that in chronic kidney disease patients with subclinical hypothyroidism, the hazard ratio for a composite endpoint of doubling of serum creatinine, end-stage renal disease, or death was 1.61, compared with euthyroid patients. [35]

A study by Sato et al suggested that in patients with heart failure, those with subclinical hypothyroidism have a worse prognosis, finding a significant increase in the rates of cardiac events and all-cause mortality in heart failure patients in the study with subclinical hypothyroidism compared with those who were euthyroid. [36]


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