Readers will recognize when to suspect treatment-refractory hypothyroidism and use a systematic diagnostic approach to determine its cause.

Directed to practitioners in endocrinology, family medicine, gastroenterology, geriatric medicine, internal medicine, and obstetrics & gynecology.

In support of improving patient care, Cleveland Clinic Center for Continuing Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

CREDIT DESIGNATION

American Medical Association (AMA) 

Cleveland Clinic Foundation Center for Continuing Education designates this journal-based activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Participants claiming CME credit from this activity may submit the credit hours to the American Osteopathic Association for Category 2 credit.

Certificate of Participation 

A certificate of participation will be provided to other health care professionals for requesting credits in accordance with their professional boards and/or associations.

American Board of Internal Medicine (ABIM)

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

**Please Note** To receive MOC you must select the MOC option during the online credit claiming process and complete the required steps. ABIM MOC points will be reported within 30 days of claiming credit.

Activity Director

Brian F. Mandell, MD, PhD
Chairman, Department of Academic Medicine, Education Institute,
Professor of Medicine, Cleveland Clinic Lerner College of Medicine
of Case Western Reserve University,
Editor in Chief, Cleveland Clinic Journal of Medicine,
Cleveland Clinic, Cleveland, OH

Co-Activity Directors

Craig D. Nielsen, MD, FACP
Vice Chairman, Department of Internal Medicine;
Associate Professor, Cleveland Clinic Lerner College of Medicine
of Case Western Reserve University, Cleveland, OH;
Governor, Ohio Chapter, American College of Physicians;
Deputy Editor, Cleveland Clinic Journal of Medicine,
Cleveland Clinic, Cleveland, OH

James C. Pile, MD
Department of Hospital Medicine;
Associate Professor, Cleveland Clinic Lerner College of Medicine
of Case Western Reserve University, Cleveland, OH;
Deputy Editor, Cleveland Clinic Journal of Medicine,
Cleveland Clinic, Cleveland, OH

George Thomas, MD, MPH
Director, Center for Blood Pressure Disorders, Department of Kidney Medicine;
Associate Professor, Cleveland Clinic Lerner College of Medicine
of Case Western Reserve University, Cleveland, OH;
Deputy Editor, Cleveland Clinic Journal of Medicine,
Cleveland Clinic, Cleveland, OH

Mary T. Cusick, MS
Executive Editor, Cleveland Clinic Journal of Medicine,
Cleveland Clinic, Cleveland, OH

Authors

Nabil William G. Sweis, MD
Department of Internal Medicine, Loyola University Medical Center, Maywood, IL

Jennifer S. Mammen, MD, PhD
Associate Professor, Division of Endocrinology, Diabetes and Metabolism,
Johns Hopkins University School of Medicine, Baltimore, MD

Associate Editors

Moises Auron, MD

Bryan Berube, MD

Daniel J. Brotman, MD

Adam J. Brown, MD

Abhijit Duggal, MD

Brian Griffin, MD

Christina A. Hermanns, MD

David L. Keller, MD

Mandy C. Leonard, PharmD

Yuebing Li, MD, PhD

Atul C. Mehta, MD

Narbeh Melikian, MBBS

Heather Muirhead, MHA

Maliha Naseer, MD

Christian Nasr, MD

Robert M. Palmer, MD, MPH

Roshan B. Patel, MD

David D.K. Rolston, MD

Gregory Rutecki, MD

Neehal Shukla, MD

Bernard J. Silver, MD

Vikas Sunder, MD

Ryan Vagedes, DO

Maximilian C. Volk, DO

Tom Kai Ming Wang, MBChB

Marc Williams, MD

Publishing Operations

Peter G. Studer, Executive Publisher

Bruce M. Marich, Production Manager

Iris Trivilino, Production Manager, Special Projects

John Thorn, Assistant Finance Director (Billing)

Editorial Staff

Mary T. Cusick, Executive Editor

Robert Litchkofski, MA, Managing Editor

Jennifer Bazil, Assistant Managing Editor

Concetta M. Caporuscio, Senior Editor

Ross Papalardo, CMI, Medical Art Director

Martin Porter, Program Manager

The information in this educational activity is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition. The viewpoints expressed in this CME activity are those of the authors/faculty. They do not represent an endorsement by The Cleveland Clinic Foundation. In no event will The Cleveland Clinic Foundation be liable for any decision made or action taken in reliance upon the information provided through this CME activity.