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<p>Patients with primary hypothyroidism and hyperthyroidism often face challenges related to unstable thyroid hormone levels despite receiving appropriate treatment. An established epidemiological association links fluctuations in thyroid function to increased cardiovascular morbidity and mortality. This instability may arise from multiple factors including comorbidities, drug interactions, variable adherence, and intrinsic fluctuations of the disease. In hypothyroidism, levothyroxine remains the cornerstone of therapy, but dose adjustments and careful monitoring are crucial, especially in elderly patients or those with cardiovascular morbidity. In hyperthyroidism, optimal management requires balancing antithyroid drug therapy to prevent both over- and undertreatment. This review explores the mechanisms behind thyroid hormone instability, its clinical consequences, and current approaches to optimise treatment, aiming to improve quality of life and reduce complications.</p>

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Gestione del paziente con ipo- e ipertiroidismo primario con funzione tiroidea instabile, nonostante trattamento appropriato

  • 期刊论文

  • 发表日期：

    2026年1月7日

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  • Simone Rodolfi,
  • Guia Maria Vannucchi,
  • Irene Campi

摘要

Patients with primary hypothyroidism and hyperthyroidism often face challenges related to unstable thyroid hormone levels despite receiving appropriate treatment. An established epidemiological association links fluctuations in thyroid function to increased cardiovascular morbidity and mortality. This instability may arise from multiple factors including comorbidities, drug interactions, variable adherence, and intrinsic fluctuations of the disease. In hypothyroidism, levothyroxine remains the cornerstone of therapy, but dose adjustments and careful monitoring are crucial, especially in elderly patients or those with cardiovascular morbidity. In hyperthyroidism, optimal management requires balancing antithyroid drug therapy to prevent both over- and undertreatment. This review explores the mechanisms behind thyroid hormone instability, its clinical consequences, and current approaches to optimise treatment, aiming to improve quality of life and reduce complications.