New Recommendation Contradicts Current Hypothyroidism Guidelines

Adults with subclinical hypothyroidism (SCH) should not be treated with thyroid hormones, according to a new recommendation from a panel of experts.

Current guidelines often recommend thyroid hormones adults with thyroid stimulating hormone (TSH) levels >10 mIU/L and for people with lower TSH values who are young or symptomatic.

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However, new guidelines from an international group of methodologists, general practitioners, internists, endocrinologists, and patient partners with SCH suggest that treatment with thyroid hormones in patients with SCH does not lead to benefits in these patients for quality of life or thyroid related symptoms.

They analyzed data from 21 trials with 2192 participants, the largest of which being the TRUST trial, a double-blind, randomized, placebo-controlled, parallel-group trial involving 737 adults with persisting SCH of at least 65 years of age.

Following their analysis, they concluded that thyroid hormones “consistently demonstrate no clinically relevant benefits for quality of life or thyroid related symptoms” (moderate to high quality evidence) and “may have little or no effect on cardiovascular events or mortality” (low quality evidence).

“If implemented, this recommendation may substantially alter prescribing trends, which show that thyroid hormones are increasingly prescribed, most probably due to SCH,” the authors wrote.

This guideline does not apply to women who are trying to become pregnant, or adults with very high TSH levels (>20 mlU/L) and with normal T4 (thyroxine) levels.

—Michael Potts

Reference:

Bekkering GE, Agoritsas T, Lytvyn L, et al. Thyroid hormones treatment for subclinical hypothyroidism: a clinical practice guideline [published May 14, 2019]. BMJ. DOI: https://doi.org/10.1136/bmj.l2006.