thyroid-gland-wikipedia

Most Patients With Subclinical Hypothyroidism May Not Require Thyroid Medication

MedicalResearch.com Interview with:
thyroid-gland-wikipediaDr. med. Martin Feller, MSc Epidemiology (LSHTM)
FMH Allgemeine Innere Medizin & Prävention und Gesundheitswesen
Scientific Research Coordinator
INSELSPITAL, Universitätsspital Bern
Universitätsklinik und Poliklinik für Allgemeine Innere Medizin (RodondiResearch)

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: SUBCLINICAL HYPOTHYROIDISM IS VERY COMMON, WITH AN ESTIMATED 13 MILLION AMERICANS AFFECTED. SUBCLINICAL HYPOTHYROIDISM IS OFTEN TREATED WITH LEVOTHYROXINE, PARTICULARLY WHEN IT CO-OCCURS WITH SYMPTOMS POTENTIALLY ATTRIBUTABLE TO HYPOTHYROIDISM SUCH AS TIREDNESS, CONSTIPATION, AND UNEXPLAINED WEIGHT GAIN. THIS PRACTICE MAY CONTRIBUTE TO LEVOTHYROXINE BEING THE MOST PRESCRIBED DRUG FROM 2014 ONWARDS IN THE US.

HOWEVER, IN OUR META-ANALYSIS OF 21 RANDOMIZED CLINICAL TRIALS, WE OBSERVED NO BENEFIT OF LEVOTHYROXINE THERAPY (COMPARED TO PLACEBO) REGARDING GENERAL QUALITY OF LIFE, THYROID-RELATED SYMPTOMS, DEPPRESSIVE SYMPTOMS, FATIGUE, COGNITIVE FUNCTION, BLOOD PRESSURE OR BODY-MASS INDEX.

MedicalResearch.com: What should readers take away from your report?

Response: MOST PATIENTS WITH SUBCLINICAL HYPOTHYROIDISM DO NOT REQUIRE LEVOTHYROXINE TREATMENT.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: OPEN QUESTIONS ARE:

(i) COULD LEVOTHYROXINE TREATMENT REDUCE CARDIOVASCULAR EVENTS? THE STUDIES WE ANALYZED IN THE META-ANALYSIS HAD A TOO SHORT FOLLOW-UP TO INFORM ABOUT CARDIOVASCULAR EVENTS. HOWEVER, THE CONDUCT OF A FUTURE RCT WITH THE PURPOSE TO EXAMINE CARDIOVASCULAR EVENTS IS HARDLY FEASIBLE, GIVEN ALSO THAT NONE WITH THIS ENDPOINT HAS BEEN SUCCESSFULLY CONDUCTED IN THE LAST 20 YEARS.

(i) COULD LEVOTHYROXINE TREATMENT CONFER BENEFIT IN THE MINORITY OF PATIENTS WITH SUBCLINICAL HYPOTHYROIDISM AND A THYROTROPIN LEVEL >10mIU/L?

(ii) COULD LEVOTHYROXINE TREATMENT CONFER BENEFIT IN PATIENTS WITH SUBCLINICAL HYPOTHYROIDISM AND “SEVERE” HYPOTHYROID SYMPTOMS? THE STUDIES WE ANALYZED IN THE META-ANALYSIS DID INSUFFICIENTLY REPORT ABOUT THE BURDEN OF HYPOTHYROID SYMPTOMS AT BASELINE.

MedicalResearch.com: Is there anything else you would like to add?

Response: WITH OUR RESULTS IN MIND, IT IS TIME TO BE MORE CAUTIOUS WITH LEVOTHYROXINE PRESCRIPTIONS FOR SUBCLINICAL HYPOTHYROIDISM.

I HAVE NO CONFLICTS OF INTEREST AND NOTHING ELSE TO DISCLOSE.

Citation:

Feller M, Snel M, Moutzouri E, et al. Association of Thyroid Hormone Therapy With Quality of Life and Thyroid-Related Symptoms in Patients With Subclinical HypothyroidismA Systematic Review and Meta-analysis. JAMA. 2018;320(13):1349–1359. doi:10.1001/jama.2018.13770

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Oct 2, 2018 @ 4:29 pm

 

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