"Could It Be My Thyroid?" The Quandary of Subclinical Hypothyroidism - Frankly Speaking EP 241

Seven percent of the US population has an active levothyroxine prescription, which is significantly greater than the number of people diagnosed with overt hypothyroidism. Many of these prescriptions appear to be for the treatment of subclinical hypothyroidism and other conditions in euthyroid individuals. Join us to uncover the latest findings on the use of levothyroxine and what the evidence tells us about appropriate use and misuse of this drug.

Episode references and resource links: 

  • Brito, J., Ross, J., El Kawkgi, O., Maraka, S., Deng, Y., Shah, N., Lipska, K. & (9000).  Levothyroxine Use in the United States, 2008-2018.  JAMA Internal Medicine, Publish Ahead of Print, doi: 10.1001/jamainternmed.2021.2686.

  • Johansen, M., Marcinek, J., Yun, J. & (2020).  Thyroid Hormone Use in the United States, 1997–2016. Journal of the American Board of Family Medicine, 33 (2), 284-288.  doi: 10.3122/jabfm.2020.02.190159. 

  • Jeffrey R. Garber, Rhoda H. Cobin,Hossein Gharib,James V. Hennessey, Irwin Klein, Jeffrey I. Mechanick, Rachel Pessah-Pollack, Peter A. Singer,Kenneth A. Woeber. Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association; November–December 2012.

  • https://www.endocrinepractice.org/article/S1530-891X(20)43030-7/fulltext; https://www.endocrinepractice.org/action/showPdf?pii=S1530-891X%2820%2943030-7

Learning Objectives

  • Define subclinical hypothyroid disorder and its correlation to overt hypothyroid disorder 
  • Discuss apparent overuse and inappropriate prescription of levothyroxine in the United States and strategies to mitigate 

Additional Information

Course summary
Available credit: 
  • 0.25 AMA PRA Category 1 Credit
Course opens: 
Course expires: 

Frank J. Domino, MD

Professor, Family Medicine and Community Health,
University of Massachusetts Medical School, Worcester, MA

Susan Feeney, DNP, FNP-BC, NP-C

Assistant Professor and Coordinator of the Family Nurse Practitioner Track


The following financial relationships have been disclosed by faculty.

Frank J. Domino, MD

Has disclosed no relevant financial relationships. 

Susan Feeney, DNP, FNP-BC, NP-C

Has disclosed no relevant financial relationships.  

Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose.

AMA PRA Category 1 Credits

Accreditation Statement

Pri-Med Institute is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Designation Statement

Pri-Med Institute designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

For APRNs and PAs, AANPCB and NCCPA accept AMA PRA Category 1 Credit™ as the number of hours of participation (AANPCB) or as Category 1 CME credits (NCCPA).

Available Credit

  • 0.25 AMA PRA Category 1 Credit
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