{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T11:39:10Z","timestamp":1789472350105,"version":"build-2803163510"},"reference-count":40,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,11,30]],"date-time":"2023-11-30T00:00:00Z","timestamp":1701302400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Thyroid hormone under\u2010replacement and over\u2010replacement are associated with adverse health outcomes. This systematic review aimed to evaluate the extent of thyroid hormone replacement adequacy for patients with known hypothyroidism in real\u2010word settings, excluding those receiving thyroid hormone suppressive therapy as thyroid cancer treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Four electronic databases (Embase [Ovid], Medline [Ovid], PubMed and SCOPUS) were searched for published and unpublished observational studies until 12 December 2022. The results of the studies were meta\u2010analysed to calculate pooled prevalence estimates for thyroid hormone supplementation adequacy, over\u2010replacement and under\u2010replacement. Quality assessment of studies was performed using the Joanna\u2010Briggs appraisal tool for prevalence studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seven studies with a total of 4230 patients were eligible for quantitative synthesis. The pooled prevalence estimates of adequate thyroid replacement, over\u2010replacement and under\u2010replacement were 0.55 (95% confidence interval [CI]: 0.49\u20130.60,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.001), 0.20 (95% CI: 0.14\u20130.27,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.001) and 0.24 (95% CI: 0.13\u20130.36,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.001), respectively. Four studies subclassified hypothyroidism and hyperthyroidism into overt and subclinical. The pooled prevalence of overt and subclinical hyperthyroidism was 0.04 (95% CI: 0.00\u20130.11,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.01) and 0.17 (95% CI: 0.09\u20130.27\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.001), respectively. For overt and subclinical hypothyroidism, the pooled prevalence was 0.02 (95% CI: 0.01\u20130.03,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.001) and 0.20 (95% CI: 0.12\u20130.29,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.001), respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>On average, approximately half of patients with hypothyroidism are only treated to target euthyroidism. In real\u2010world practice, a significant number of patients are over\u2010treated or under\u2010treated, leading to adverse healthcare outcomes. It is imperative that more effective thyroid monitoring strategies be implemented, with an emphasis on primary care thyroid function monitoring, to minimise inappropriate thyroid replacement treatments and optimise healthcare outcomes at a population level.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cen.14998","type":"journal-article","created":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T01:34:10Z","timestamp":1701394450000},"page":"488-501","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Adequacy of thyroid hormone replacement for people with hypothyroidism in real\u2010world settings: A systematic review and meta\u2010analysis of observational studies"],"prefix":"10.1111","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5296-6638","authenticated-orcid":false,"given":"Agathoklis","family":"Efthymiadis","sequence":"first","affiliation":[{"name":"Oxford University Hospitals NHS Trust Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Henry","sequence":"additional","affiliation":[{"name":"Bodleian Health Care Libraries University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Spinos","sequence":"additional","affiliation":[{"name":"Gloucester NHS Foundation Trust Gloucester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianthi","family":"Bourlaki","sequence":"additional","affiliation":[{"name":"Sandwell and West Birmingham NHS Trust Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandros","family":"Tsikopoulos","sequence":"additional","affiliation":[{"name":"1st Department of Otorhinolaryngology\u2010Head and Neck Surgery, AHEPA University General Hospital Aristotle University of Thessaloniki Kiriakidi 1 Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angeliki","family":"Bourazana","sequence":"additional","affiliation":[{"name":"2<sup>nd<\/sup> Department of Cardiology University Hospital of Larissa Larissa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasios","family":"Bastounis","sequence":"additional","affiliation":[{"name":"School of Health and Related Research (ScHARR), Regent Court University of Sheffield Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Tsikopoulos","sequence":"additional","affiliation":[{"name":"Aristotle University of Thessaloniki Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,11,30]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30703-1"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-2409"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.13440"},{"key":"e_1_2_10_5_1","first-page":"104","article-title":"Prevalence and predictors of adequate treatment of overt hypothyroidism \u2010 a population\u2010based study","volume":"21","author":"Lindg\u00e5rd Nielsen J","year":"2022","journal-title":"EXCLI J"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcq222"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.9052"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.3803\/EnM.2020.728"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-020-02259-8"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2006.0252"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-017-0777-9"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2012.1159"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2009-2571"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2009-1625"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2017.0517"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_10_17_1","unstructured":"Healthcare Improvement Scotland SIGN. 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