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Methods| We conducted a retrospective analysis of deidentified administrative claims data linked with laboratory results from OptumLabs Data Warehouse, which includes commercially insured and Medicare Advantage enrollees throughout the US. 5 The study was deemed not to require Mayo Clinic Institutional Review Board review owing to the use of deidentified data in accordance with the Code of Federal Regulations, 45 CFR 46.102. The cohort included adults (≥ 18 years of age) who newly filled levothyroxine prescriptions between January 1, 2008, and December 31, 2018, and who had a thyrotropin level measured within 3 months prior to levothyroxine initiation. We excluded people with a history of thyroid surgery, thyroid cancer, or central hypothyroidism and pregnant women. We used descriptive statistics to characterize trends in thyrotropin levels and categories of thyroid function measured prior to …