{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T18:19:20Z","timestamp":1783448360480,"version":"3.55.0"},"reference-count":68,"publisher":"Bioscientifica","issue":"4","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":94,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["journals.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hypothyroidism often impairs quality of life (QoL). This network meta-analysis (NMA) evaluated the efficacy and safety of additional interventions alongside levothyroxine (LT4).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study adhered to the PRISMA guidelines and is registered on PROSPERO (CRD420251085765). PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched for randomized controlled trials (RCTs) on the treatment of hypothyroidism. A Bayesian NMA was performed, reporting standardized mean differences (SMDs) or risk ratios (RRs) with 95% credible intervals (CrIs). Evidence certainty was assessed using the CINeMA framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty-five RCTs involving 3,508 patients were included. Compared with placebo, levothyroxine (LT4) + aerobic training (AT) + resistance training (RT) significantly reduced thyroid-stimulating hormone (TSH) levels (SMD = \u22123.97, 95% CrI: \u22125.76, \u22122.18, CINeMA: high certainty); LT4 + zinc (Zn) + magnesium (Mg) + vitamin A (VA) raised free thyroxine (FT4) (SMD = 1.95, 95% CrI: 1.37, 2.53, CINeMA: high certainty); and LT4 + Zn increased free triiodothyronine (FT3) (SMD = 1.46, 95% CrI: 0.40, 2.51, CINeMA: low certainty). In addition, LT4 + AT + RT significantly improved QoL score (SMD = 1.62, 95% CrI: 0.78, 2.46) and mental health score (MHS) (SMD = 2.1, 95% CrI: 1.19, 3.01, CINeMA: low certainty) compared with LT4 alone. LT4 + RT significantly improved physical function score (SMD = 1.59, 95% CrI: 0.76, 2.43). Liothyronine (LT3) increased adverse events versus placebo (RR = 15.54, 95% CrI: 2.68, 501.14, CINeMA: very low certainty).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The combination of LT4, AT, and RT may be the preferred strategy for reducing TSH, enhancing QoL, and improving MHS. Clinical interventions should be tailored based on individual patient profiles.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1530\/ec-26-0011","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T16:48:30Z","timestamp":1773679710000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-10","source":"Crossref","is-referenced-by-count":0,"title":["Additional treatment strategies for hypothyroidism: a network meta-analysis"],"prefix":"10.1530","volume":"15","author":[{"given":"Xingang","family":"Lv","sequence":"first","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wentao","family":"Qin","sequence":"additional","affiliation":[{"name":"2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiarui","family":"Li","sequence":"additional","affiliation":[{"name":"1"},{"name":"3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8378-1564","authenticated-orcid":true,"given":"Likun","family":"Du","sequence":"additional","affiliation":[{"name":"1"},{"name":"3"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"2026070714065547400_bib1","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1016\/S0140-6736(24)01614-3","article-title":"Hypothyroidism","volume":"404","author":"Taylor","year":"2024","journal-title":"Lancet"},{"key":"2026070714065547400_bib2","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1038\/nrendo.2018.18","article-title":"Global epidemiology of hyperthyroidism and hypothyroidism","volume":"14","author":"Taylor","year":"2018","journal-title":"Nat Rev Endocrinol"},{"key":"2026070714065547400_bib3","doi-asserted-by":"crossref","first-page":"17","DOI":"10.2165\/11598070-000000000-00000","article-title":"Overt and subclinical hypothyroidism: who to treat and how","volume":"72","author":"Khandelwal","year":"2012","journal-title":"Drugs"},{"key":"2026070714065547400_bib4","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1093\/bmb\/ldr030","article-title":"The epidemiology of thyroid disease","volume":"99","author":"Vanderpump","year":"2011","journal-title":"Br Med Bull"},{"key":"2026070714065547400_bib5","article-title":"Epidemiology, types, causes, clinical presentation, diagnosis, and treatment of hypothyroidism","volume":"15","author":"Zamwar","year":"2023","journal-title":"Cureus"},{"key":"2026070714065547400_bib6","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/s41572-022-00357-7","article-title":"Hypothyroidism","volume":"8","author":"Chaker","year":"2022","journal-title":"Nat Rev Dis Primers"},{"key":"2026070714065547400_bib7","doi-asserted-by":"crossref","DOI":"10.2196\/54078","article-title":"Enhancing quality of life in patients with hypothyroidism using a scientific yoga module: randomized controlled trial","volume":"27","author":"Nilkantham","year":"2025","journal-title":"J Med Internet Res"},{"key":"2026070714065547400_bib8","doi-asserted-by":"crossref","DOI":"10.1016\/j.ctcp.2023.101795","article-title":"Effects of aerobic, resistance, and combined training on thyroid function and quality of life in hypothyroidism. 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