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The widely used definition of Case Based Reasoning (CBR) is similar cases of a certain problem has related solutions. Likewise, it is widely assumed that similar differences among case descriptions imply similar differences among their solutions. In this case, CBR looks to be a best solution to many unresolved medical questions and medical knowledge based systems, like in the case of hypothyroidism treatment. The main challenge, however, in finding the best solution in treating hypothyroidism with the exact dosage of levothyroxine therapy is each case is unique and difficult to derive conclusions from the previous cases (reasons). Some researches imply that case based reasoning through adaptation has a challenge in treating hypothyroidism. Nevertheless, CBR would be successful if the adaptation issue is solved. Adaptation is one of the most problematic steps in the design and development of case-based reasoning (CBR) systems. Recently, some researches have been done and scientific discussions are emerging to solve the adaptation issue. So, in this paper, I would discuss the role of adaptation in the design and development of case-based reasoning in treating hypothyroidism as well as assess the recently emerged CBR adaptation techniques and their implication to the hypothyroid treatment.