Does Thyroid Hormone Treatment Benefit Patients with Subclinical Hypothyroidism?
BACKGROUND AND PURPOSE:
Defined as elevated thyrotropin with normal range free thyroxine
More common in women
Often treated with thyroid hormone, especially if women present with symptoms related to fatigue, constipation or weight gain
Feller et al. (JAMA, 2018) sought to determine whether thyroid hormone therapy was associated with improvement in quality of life and thyroid-related symptoms in individuals with subclinical hypothyroidism
Systematic review and meta-analysis
Non-pregnant adults with subclinical hypothyroidism
Included RCTs that compared thyroid hormone therapy to
Two independent reviewers extracted data to avoid bias and quality of evidence was assessed with GRADE methods tool
Minimum follow-up of 3 months
Defined as a thyrotropin level above reference range in combination with a free thyroxine level within the reference range (center-specific reference ranges)
General quality of life
21 studies were included | 2192 patients were randomized
Duration of treatment ranged from 3-18 months
Thyroid hormone therapy lowered the mean thyrotropin value into the normal reference range compared with placebo
Thyroid treatment was not associated with
Benefit regarding general quality of life (95% CI, −0.25 to 0.03)
Thyroid-related symptoms (95% CI, −0.12 to 0.14)
Risk of bias was low | Quality of evidence assessed with the GRADE tool was judged moderate to high
Thyroid hormone therapy was not associated with improvements in general quality of life or thyroid-related symptoms in patients with subclinical hypothyroidism
The authors state
These findings do not support the routine use of thyroid hormone therapy in adults with subclinical hypothyroidism
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