CLINICAL MANAGEMENT, LIFESTYLE FACTORS, AND QUALITY OF LIFE IN HYPOTHYROIDISM: A SYSTEMATIC REVIEW

This systematic review synthesizes contemporary evidence on the management of hypothyroidism, with a focus on pharmacologic therapy, lifestyle factors, and quality of life (QoL). Eligible studies included adults with overt or subclinical hypothyroidism and reported data on thyroid specific or generic QoL, biochemical outcomes, or cardiometabolic markers under pharmacologic and/or lifestyle exposures. The literature comprised narrative reviews, randomized controlled trials, observational studies, and instrument validation papers. Across studies, levothyroxine (LT4) monotherapy effectively normalized TSH in most patients, yet a notable subset continued to experience fatigue, weight concerns, and cognitive or mood symptoms despite biochemical euthyroidism. Emerging approaches-such as LT4 plus liothyronine (LT3) and slow release T3 formulations-showed more physiological T3 profiles and patient preference in some trials, but consistent superiority over LT4 alone in QoL or symptom relief has not been demonstrated, and long term safety data remain limited. Observational work linked lifestyle patterns (short or long sleep, low physical activity, unhealthy diet, smoking, excess weight) with less favorable thyroid indices and poorer QoL, while endurance training interventions in subclinical hypothyroidism improved fatigue and health related QoL without major changes in thyroid hormone levels.