Panel advises against hormone treatment for mild hypothyroidism

  • Bekkering GE & al.
  • BMJ
  • 14 May 2019

  • International Clinical Digest
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Takeaway

  • A clinical practice guideline concludes that thyroid hormones have no relevant clinical benefit for patients with subclinical hypothyroidism (SCH).

Why this matters

  • Thyroid hormones are increasingly prescribed, likely due to SCH; this recommendation may alter prescribing trends.

Key points

  • The expert panel issued a strong recommendation against thyroid hormone in adults with SCH (elevated thyroid-stimulating hormone [TSH] levels with normal free thyroxine levels).
    • This recommendation includes patients with no symptoms or nonspecific symptoms.
    • This recommendation does not apply to women trying to become pregnant or patients with TSH >20 mIU/L.
    • This recommendation may not apply to patients with severe symptoms or to young adults (≤30 years old).

Study design

  • 21 trials with 2192 participants were included in a systematic review to develop the clinical practice guideline.
  • The guideline panel included methodologists, general practitioners, internists, endocrinologists, and patient partners.
  • Funding: None.

Limitations

  • Uncertainty about potential harms of thyroid hormone treatment.