{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T10:20:15Z","timestamp":1767349215443,"version":"3.48.0"},"reference-count":21,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T00:00:00Z","timestamp":1759708800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the association between health literacy levels and biochemical control of hypothyroidism, measured by serum TSH and free thyroxine (FT4) levels, in patients receiving levothyroxine (L\u2010T4) therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a cross\u2010sectional study at the Thyroid Disorders Outpatient Clinic, Escola Paulista de Medicina, Universidade Federal de S\u00e3o Paulo (EPM\/UNIFESP), between April and December 2024. The protocol was approved by the institutional ethics committee (CAAE: 76540423.5.0000.5505), and all participants provided written informed consent. Adult patients aged 18\u201365 years with primary hypothyroidism on levothyroxine (L\u2010T4) therapy were screened; 274 met eligibility criteria after exclusions. Health literacy was assessed using the Brazilian\u2010Portuguese Newest Vital Sign (NVS), administered face\u2010to\u2010face by trained staff. Demographic and clinical data, including comorbidities, L\u2010T4 dose, TSH, and FT4 levels, were extracted from electronic records. Biochemical analyses were performed using electrochemiluminescence immunoassays. Statistical analyses included ANOVA, \u03c7\u00b2 tests, and generalised linear regression, with significance set at\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 274 patients included in the final analysis, health literacy was inversely associated with serum TSH levels, and this association remained significant in fully adjusted models. A marginal trend was observed for FT4, but it did not reach statistical significance after adjustment. Patients with lower literacy scores required higher levothyroxine doses per kilogram, suggesting less efficient treatment control. No significant differences in comorbidities were observed across literacy strata.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Limited health literacy was independently associated with poorer biochemical control of hypothyroidism, reflected by higher TSH concentrations and greater levothyroxine dose requirements. These findings reinforce health literacy as a modifiable determinant of treatment success. Incorporating literacy\u2010sensitive strategies\u2014such as plain\u2010language counselling, teach\u2010back techniques, and visual aids\u2014into routine care may help stabilise TSH, optimise levothyroxine therapy, and improve long\u2010term outcomes in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cen.70047","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T05:30:00Z","timestamp":1759815000000},"page":"167-174","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Influence of Health Literacy on the Control of Hypothyroidism in Patients Under Levothyroxine Treatment"],"prefix":"10.1111","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4029-5401","authenticated-orcid":false,"given":"Jessyka Krause","family":"Meneses","sequence":"first","affiliation":[{"name":"Endocrinology Unit, Department of Medicine, Escola Paulista de Medicina Universidade Federal de S\u00e3o Paulo (EPM\/UNIFESP) S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniella Araujo","family":"Muniz","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, Department of Medicine, Escola Paulista de Medicina Universidade Federal de S\u00e3o Paulo (EPM\/UNIFESP) S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D\u00e9bora","family":"Moroto","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, Department of Medicine, Escola Paulista de Medicina Universidade Federal de S\u00e3o Paulo (EPM\/UNIFESP) S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0204-3552","authenticated-orcid":false,"given":"Jo\u00e3o Roberto Maciel","family":"Martins","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, Department of Medicine, Escola Paulista de Medicina Universidade Federal de S\u00e3o Paulo (EPM\/UNIFESP) S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9383-7907","authenticated-orcid":false,"given":"Carolina Castro Porto Silva","family":"Janovsky","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, Department of Medicine, Escola Paulista de Medicina Universidade Federal de S\u00e3o Paulo (EPM\/UNIFESP) S\u00e3o Paulo Brazil"},{"name":"INTEGRA Clinical Research Center S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,10,6]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/bmb\/ldr030"},{"key":"e_1_2_10_3_1","unstructured":"Minist\u00e9rio da Sa\u00fade (BR). Preval\u00eancia de doen\u00e7as da tireoide. Bol Epidemiol. Bras\u00edlia (DF): Minist\u00e9rio da Sa\u00fade;2020."},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.4065\/84.1.65"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2014.0028"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2013.258"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapro\/15.3.259"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-12-80"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-155-2-201107190-00005"},{"issue":"1","key":"e_1_2_10_10_1","first-page":"49","article-title":"Measuring Health Literacy in Individuals With Diabetes","volume":"99","author":"Al Sayah F.","year":"2013","journal-title":"Diabetes Research and Clinical Practice"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/0145721714540220"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/10810730.2011.604389"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/10810730.2014.936571"},{"key":"e_1_2_10_14_1","unstructured":"D. A.DeWalt L. F.Callahan V. H.Hawk et al. Health Literacy Universal Precautions Toolkit. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ);2010."},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.27.12.2980"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.92.8.1278"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1080\/10810730.2011.604388"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/0738-3991(95)00787-3"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.5993\/AJHB.31.s1.3"},{"issue":"4","key":"e_1_2_10_20_1","first-page":"321","article-title":"Evidence\u2010Based Health Communication Strategies in Patient Care","volume":"322","author":"Schaab M.","year":"2019","journal-title":"Journal of the American Medical Association"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0034-89102009005000031"},{"issue":"3","key":"e_1_2_10_22_1","first-page":"226","article-title":"Use of Pictograms to Improve Medication Adherence","volume":"54","author":"Shaji K. S.","year":"2012","journal-title":"Indian Journal of Psychiatry"}],"container-title":["Clinical Endocrinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cen.70047","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T10:15:31Z","timestamp":1767348931000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cen.70047"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,6]]},"references-count":21,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1111\/cen.70047"],"URL":"https:\/\/doi.org\/10.1111\/cen.70047","archive":["Portico"],"relation":{},"ISSN":["0300-0664","1365-2265"],"issn-type":[{"type":"print","value":"0300-0664"},{"type":"electronic","value":"1365-2265"}],"subject":[],"published":{"date-parts":[[2025,10,6]]},"assertion":[{"value":"2025-06-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}