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Thyroid hormone treatment: no proof of benefit in asymptomatic subclinical hypothyroidism

According to a systematic review of comparative trials in approximately 2 000 patients, symptomless hypothyroidism discovered incidentally does not require thyroid hormone treatment (levothyroxine).

So-called subclinical hypothyroidism is characterised by an elevated blood level of the pituitary hormone TSH but with a normal blood concentration of the thyroid hormone free T4.

Symptoms reported in subclinical hypothyroidism are rare and are not very specific. The progression to proven hypothyroidism is slow and inconsistent.

As of early 2020, there is no strong evidence of a benefit of thyroid hormone treatment, most commonly levothyroxine, in reducing mortality or the frequency of cardiovascular complications in adults with subclinical hypothyroidism.

In 2018, a systematic review of clinical trials (approximately 2 000 patients in total) evaluated the effect of this treatment on patients’ self-reported symptoms and quality of life.

This review showed no perceptible effect for patients on the following criteria: symptoms considered to be related to hypothyroidism, fatigue, depressive symptoms, cognitive function. Likewise for the quality of life evaluated by different scores and body mass index after 12 months of thyroid hormone treatment. This supports the option of not routinely offering thyroid hormone treatment to patients with asymptomatic, incidentally discovered subclinical hypothyroidism.

©Prescrire 1 June 2020

Source: "Subclinical hypothyroidism. No proof of benefit from treatment with thyroid hormone" Prescrire International 2020; 29 (216): 160. Subscribers only.

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See also:

"Hypothyroidism in adults.
Levothyroxine if warranted by
clinical and laboratory findings,
not for simple TSH elevation"
Prescrire Int 2015;
24 (164): 24 -246.
Pdf, subscribers only

Hypothyroidism in adults:
treat patients exhibiting
symptoms
(October 2015)
Free


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