Treatment Doesn't Improve Subclinical Hypothyroidism Symptoms

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A JAMA study finds that treating elderly patients who have  subclinical hypothyroidism does not improve hypothyroid symptoms or fatigue.

The study, published Oct. 30, examines treatment with levothyroxine in men and women 80 years old or older who are increasinly frail and have other comorbidities.

While there have been clinical trials of levothyroxine in younger populations, it has not been tested in older populations with subclinical hypothyroidism who report symptoms of constipation, mental slowness, fatigue, or depression. The conditon has also been associated with an increased risk of cardiovascular disease.

Led by Simon P. Mooijaart, M.D., Ph.D., of Leiden University Medical Center, the Netherlands, researchers analyzed data from two randomized clinical trials of 212 participants (84 percent completed the trial) who were randomized to receive levothyroxine or a placebo. In this case, the patients had mildly elevated thyrotropin levels and few symptoms.

The hypothyroid symptoms score decreased from 21.7 at baseline to 19.3 at 12 months in the levothyroxine group vs from 19.8 at baseline to 17.4 at 12 months in the placebo group.

By comparison, tiredness increased from 25.5 at baseline to 28.2 at 12 months in the levothyroxine group vs from 25.1 at baseline to 28.7 at 12 months in the placebo group.

Almost 30 percent of members of the treatment group experienced an adverse event with the most commong being a cerebrovascular accident occuring in three patients.

"These findings do not support routine use of levothyroxine for managing subclinical hypothyroidism in adults aged 80 years and older," the authors wrote.

Currently, both U.S.-based and European Union (EU) treatment guidelines do not recommend routine treatment for individuals 80 years and older with subclinical hypothyroidism with the exception of individuals with thyrotropin levels of 10 mIU/L or higher. EU guidelines suggests ongoing monitoring of thyroid function in patients older than 80 years with subclinical hypothyroidism.

REFERENCE

Simon P. Mooijaart, MD, PhD; Robert S. Du Puy, MD; David J. Stott, MD; et al. "Association Between Levothyroxine Treatment and Thyroid-Related Symptoms Among Adults Aged 80 Years and Older With Subclinical Hypothyroidism." JAMA. Oct. 30, 2019. DOI:https://doi.org/10.1001/jama.2019.17274