When subclinical hypothyroidism becomes clinically diagnosed

Published:September 29, 2017DOI:
      Lili Ilse Elvenes (*1882 Denmark–†1931 Germany) was one of the first transgender women who ultimately died from on a series of risky and essentially unproven operations to remove her male parts and transplant female reproductive organs. Her remarkable life history – made into ‘The Danish Girl’ and the learnings thereof – carries important messages about how we, citizens and doctors alike, should deal with hormonal conditions. There are instructive parallels with other disorders, for example, insufficiency of the thyroid gland. The Danish girls and boys of today, who suffer hypothyroidism, have a similar mix of signs and symptoms, intended- and unintended effects of treatment, and placebo- and nocebo-effects, thus posing us with an emergent socio-, and medical challenge.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Chaker L.
        • Bianco A.C.
        • Jonklaas J.
        • Peeters R.P.
        Lancet. 2017; (ePub)
        • Danish National Board of Health
        Thyroxine prescription levels in Denmark., 2016 (Available from:)
        • Madariaga A.G.
        • Santos Palacios S.
        • Guillén-Grima F.
        • Galofré J.C
        The incidence and prevalence of thyroid dysfunction in Europe: A meta-analysis.
        J Clin Endocrinol Metab. 2014; 99: 923-931
        • Canaris G.J.
        • Manowitz N.R.
        • Mayor G.
        • Ridgway E.C.
        The colorado thyroid disease prevalence study.
        Arch Intern Med. 2000; 160: 526
        • Danish Endocrine Society
        National guidelines for endocrinology.
        • Okosieme O.
        • Gilbert J.
        • Abraham P.
        • Boelaert K.
        • Dayan C.
        • Gurnell M.
        • et al.
        Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee.
        Clin Endocrinol. 2016; 84: 799-808
        • Rugge J.B.
        • Bougatsos C.
        • Chou R.
        Screening and treatment of thyroid dysfunction: an evidence review for the U.S. preventive services task force.
        Ann Intern Med. 2015; 162: 35
        • Razvi S.
        • Weaver J.U.
        • Butler T.J.
        • Pearce S.H.S.
        Levothyroxine treatment of subclinical hypothyroidism, fatal and nonfatal cardiovascular events, and mortality.
        Arch Intern Med. 2012; 172: 645-649
        • Jones C.M.
        • Boelaert K.
        The endocrinology of ageing: a mini-review.
        Gerontology. 2015; 61: 291-300
        • Villar H.
        • Saconato H.
        • Valente O.
        • Atallah A.
        Thyroid hormone replacement for subclinical hypothyroidism.
        Cochrane Database Syst Rev. 2007; CD003419
        • Stott D.J.
        • Rodondi N.
        • Kearney P.M.
        • Ford I.
        • Westendorp R.G.J.
        • Mooijaart S.P.
        • et al.
        Thyroid hormone therapy for older adults with subclinical hypothyroidism.
        N Engl J Med. 2017; 376: 2534-2544
        • Collet T.-H.
        • Gussekloo J.
        • Bauer D.C.
        • den Elzen W.P.J.
        • Cappola A.R.
        • Balmer P.
        • et al.
        Subclinical hyperthyroidism and the risk of coronary heart disease and mortality.
        Arch Intern Med. 2012; 172: 2113-2122
        • Rodriguez-Gutierrez R.
        • Maraka S.
        • Ospina N.S.
        • Montori V.M.
        • Brito J.P.
        • Surks M.
        Levothyroxine overuse: time for an about face?.
        Lancet Diabetes Endocrinol. 2017; 5: 246-248