The Influence of Health Literacy on the Control of Hypothyroidism in Patients Under Levothyroxine Treatment
Authors' conclusion
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-sensitive strategies-such as plain-language counselling, teach-back techniques, and visual aids-into routine care may help stabilise TSH, optimise levothyroxine therapy, and improve long-term outcomes in this population.
Study context
- Population
- Adults aged 18–65 years with primary hypothyroidism on LT4 therapy, Thyroid Disorders Outpatient Clinic, EPM/UNIFESP, April–December 2024
- Participants
- 274 adults
- Exposure
- Health literacy levels vs biochemical control of hypothyroidism
- Outcome
- Association between health literacy and biochemical control (serum TSH and FT4)
Methodological detailssingle-centre, Health literacy assessed with Brazilian-Portuguese Newest Vital Sign, face-to-face by trained staff
- Single-centre
- Health literacy assessed with Brazilian-Portuguese Newest Vital Sign, face-to-face by trained staff
Main finding
As reported in the abstract
- Health literacy inversely associated with serum TSH; remained significant in fully adjusted models
- Marginal trend for free thyroxine (FT4), not significant after adjustment
- Fully adjusted models
Observational data: associations, not effects.
Further findings
LT4 dose per kg
- Lower literacy scores required higher LT4 doses per kg
Comorbidities
- No significant differences in comorbidities across literacy strata
Original publication
The Influence of Health Literacy on the Control of Hypothyroidism in Patients Under Levothyroxine Treatment. Clin Endocrinol (Oxf). Published 6 October 2025. doi:10.
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