|| Checking for direct PDF access through Ovid
Maintaining performance levels in athletes remains challenging when metabolic disturbances may be suspected clinically. In athletes there are reported deviations from normal range lab values and multiple factors that may lead to clinical suspicion of thyroid disease, including hypothyroidism, hyperthyroidism, and thyroiditis. Reports of exogenous thyroxine use in athletes and anabolic use further complicate the clinical picture, and clinicians must exercise judgment in regards to thyroid screening and interpretation of value variables such as age and exercise level. Return-to-play issues must be addressed when implementing hormone replacement, and consideration of serial laboratory values may be considered.