In patients with hypothyroidism who continue to experience symptoms despite “normal” laboratory values, clinicians should first consider alternative causes before attributing symptoms solely to thyroid dysfunction, explained an endocrinologist.

Rosemarie Lajara, MD, FACE, a staff physician at Southern Endocrinology and Diabetes Associates, spoke about managing patients with hypothyroidism who continue to experience symptoms despite laboratory results considered within the normal range during the Endocrine Society (ENDO) Annual Meeting 2026 and later discussed clinical considerations in an interview with HCPLive.

In Part 2 of our interview, Lajara emphasized the importance of avoiding diagnostic anchoring on thyroid laboratory values alone and ensuring that other common contributors to fatigue are appropriately evaluated.

“I think you have to exclude other confounders,” Lajara said. “Make sure that the vitamin panels are in range, making sure that we're not dealing with an adrenal issue, that we're not dealing with absorption problems like celiac, IBS, or other comorbid conditions that can be masked through the fatigue.”

She noted that fatigue is a nonspecific symptom that requires a broader diagnostic approach, as it may reflect multiple underlying conditions beyond thyroid dysfunction.

“Fatigue is such a general term,” she said. “It could be anything from thyroid to anemia, right? So we need to make sure that we're trying to do a little bit of detective work here as a clinician and try to find out whether there's something else contributing to the symptoms.”

In cases where other causes have been excluded, Lajara said clinicians should also consider whether medication absorption or formulation differences may be preventing optimal treatment response in individual patients.

“If everything else is normal, then you can decide and have a discussion about different formulations, because absorption may be the driver of not being in an optimized range for that individual,” she said.

Lajara added that clinicians should remain attentive to patient-reported experiences and avoid over-reliance on laboratory markers, particularly when time constraints can limit more detailed evaluation.

Ultimately, she encouraged a structured yet individualized approach to assessment, ensuring that persistent symptoms are not dismissed solely on the basis of “normal” laboratory result.

Editor’s Note: Lajara reports relevant disclosures with AstraZeneca, Boehringer Ingelheim, Eli Lilly Company, Novo Nordisk, Sanofi and Zealand, and others.

References

1. Lajara R. BEYOND THE NUMBERS: Unmasking the Symptom Gap in Hypothyroidism Management. Lecture presented at: ENDO Annual Conference; June 13, 2026; Chicago, IL.

2. Razvi S, Mrabeti S, Luster M. Managing symptoms in hypothyroid patients on adequate levothyroxine: a narrative review. Endocrine Connections. 2020;9(11):R241-R250. doi:https://doi.org/10.1530/EC-20-0205