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Evidence summaries

Thyroid Hormone Replacement for Subclinical Hypothyroidism

Levothyroxine replacement therapy appears not to improve quality of life or thyroid-related symptoms in nonpregnant adults with subclinical hypothyroidism.Level of evidence: "B"

A Cochrane review [Abstract] 1 included 12 studies with a total of 350 subjects. Eleven trials investigated levothyroxine replacement with placebo, one study compared levothyroxine replacement with no treatment. No studies were identified that assessed (cardiovascular) mortality or morbidity. Seven studies evaluated symptoms, mood and quality of life with no statistically significant improvement. One study showed a statistically significant improvement in cognitive function. Six studies assessed serum lipids, there was a trend for reduction in some parameters following levothyroxine replacement. Some echocardiographic parameters improved after levothyroxine replacement therapy, like myocardial relaxation, as indicated by a significant prolongation of the isovolumic relaxation time as well as diastolic dysfunction. Only four studies reported adverse events with no statistically significant differences between groups.

A systematic review 2 included 21 studies with a total of 2 192 subjects comparing thyroid hormone therapy (3-18 months) with placebo or no therapy in nonpregnant adults with subclinical hypothyroidism. Thyroid hormone therapy lowered the mean TSH value into the normal reference range compared with placebo but did not increased general quality of life (SMD -0.11, 95% CI -0.25 to 0.03; statistical heterogeneity I2 =66.7%; n=796) or thyroid-related symptoms (SMD 0.01, 95% CI -0.12 to 0.14; n=858).

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and blinding).

References

  • Villar HC, Saconato H, Valente O, Atallah AN. Thyroid hormone replacement for subclinical hypothyroidism. Cochrane Database Syst Rev 2007 Jul 18;(3):CD003419. [PubMed]
  • Feller M, Snel M, Moutzouri E et al. Association of Thyroid Hormone Therapy With Quality of Life and Thyroid-Related Symptoms in Patients With Subclinical Hypothyroidism: A Systematic Review and Meta-analysis. JAMA 2018;320(13):1349-1359. [PubMed]

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