Sub-clinical hypothyroidism: new guidelines


  • Mary Corcoran
  • Univadis Medical News
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A panel of international experts has issued a strong recommendation against prescribing thyroid hormones for adults with sub-clinical hypothyroidism (SCH). 

The advice is part of the BMJ’s ‘Rapid Recommendations’ initiative and is based on new evidence which showed that hormone therapy does not improve quality of life or symptoms, including low mood and fatigue, in this patient population. 

The review of data from 21 trials involving 2,192 participants compared the effects of thyroid hormone treatment with no treatment or placebo in adults with SCH.

It found that for adults with SCH, thyroid hormones consistently demonstrated no clinically relevant benefits for quality of life or thyroid-related symptoms, including depressive symptoms, fatigue and body mass index (BMI). Thyroid hormone also had little or no effect on cardiovascular events or mortality. The authors also said they could not rule out the possibility of harms with treatment. 

Instead the authors advised clinicians to monitor the progression or resolution of thyroid dysfunction in these adults. 

The recommendation does not apply to women who are trying to become pregnant or patients with particularly high thyroid stimulating hormone (TSH) levels (>20 mIU/L). It may also not apply to patients with severe symptoms or those aged below 30 years.

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