Grand Rounds

Does Thyroid Hormone Treatment Benefit Patients with Subclinical Hypothyroidism?

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

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

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

These findings do not support the routine use of thyroid hormone therapy in adults with subclinical hypothyroidism

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