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Objective  To evaluate β‐cell function and insulin sensitivity in subjects with overt (OH) and subclinical hypothyroidism (SH) before and after T4 replacement therapy.

Background  Disturbances in glucose metabolism have been observed in hypothyroid states. However, the clinical significance and potential reversibility of these alterations by T4 replacement therapy remain to be elucidated especially in patients with SH.

Design and patients  Parameters of glucose metabolism have been investigated in subjects with OH (n = 12) and SH (n = 11). Insulin sensitivity has been assessed by the euglycaemic–hyperinsulinaemic clamp technique and β‐cell function by mathematical modelling of data derived from an oral glucose tolerance test.

Results  Fasting and dynamic glycaemia as assessed by the AUC_Glucose remained unaltered following substitution therapy (P > 0·05). Insulin sensitivity significantly improved …