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#Grand Rounds

Does Thyroid Hormone Treatment Benefit Patients with Subclinical Hypothyroidism?

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BACKGROUND AND PURPOSE: 

  • Subclinical hypothyroidism  
    • 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

METHODS: 

  • Systematic review and meta-analysis  
    • Non-pregnant adults with subclinical hypothyroidism  
    • Included RCTs that compared thyroid hormone therapy to  
      • Placebo or  
      • No therapy  
  • Two independent reviewers extracted data to avoid bias and quality of evidence was assessed with GRADE methods tool  
  • Minimum follow-up of 3 months 
  • Subclinical hypothyroidism 
    • Defined as a thyrotropin level above reference range in combination with a free thyroxine level within the reference range (center-specific reference ranges) 
  • Primary outcomes  
    • General quality of life  
    • Thyroid-related symptoms

RESULTS: 

  • 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

CONCLUSION: 

  • 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

Learn More – Primary Sources: 

Association of Thyroid Hormone Therapy With Quality of Life and Thyroid-Related Symptoms in Patients With Subclinical Hypothyroidism – A Systematic Review and Meta-analysis

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Related ObG Topics:

Subclinical Hypothyroidism and Pregnancy Outcome – Is There a Relationship?
Should Levothyroxine be Used to Treat Subclinical Hypothyroidism?
Infertility Evaluation: Who, When and How

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