A Randomized Controlled Trial of the Effect of Thyroxine Replacement on Cognitive Function in Community-Living Elderly Subjects with Subclinical Hypothyroidism: The Birmingham Elderly Thyroid Study

Parle, James; Roberts, Lesley; Wilson, Sue; Pattison, Helen; Roalfe, Andrea; Haque, Sayeed; Heath, Craig; Sheppard, M. C.; Franklyn, Jayne A.; Hobbs, FD Richard

doi:10.1210/jc.2009-2571

Cited by 156 publications

(174 citation statements)

References 33 publications

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“…There are few clinical, randomized and placebo--controlled trials that have evaluated the impact of treatment on these outcomes. Some trials have demonstrated beneficial effects (113)(114)(115)(116), while others did not confirm these results (117)(118)(119)(120). In the elderly with SCH, a randomized study showed that treatment with levothyroxine does not improve cognitive function compared with a placebo (120), although only 27 of the 42 placebo-treated patients completed the study, which may have influenced the results.…”

Section: When Should Sch Be Treated?mentioning

confidence: 99%

Consenso brasileiro para a abordagem clínica e tratamento do hipotireoidismo subclínico em adultos: recomendações do Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia

Sgarbi

Teixeira

Maciel

et al. 2013

Arq Bras Endocrinol Metab

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Introduction: Subclinical hypothyroidism (SCH), defined as elevated concentrations of thyroid stimulating hormone (TSH) despite normal levels of thyroid hormones, is highly prevalent in Brazil, especially among women and the elderly. Although an increasing number of studies have related SCH to an increased risk of coronary artery disease and mortality, there have been no randomized clinical trials verifying the benefit of levothyroxine treatment in reducing these risks, and the treatment remains controversial. Objective: This consensus, sponsored by the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism and developed by Brazilian experts with extensive clinical experience with thyroid diseases, presents these recommendations based on evidence for the clinical management of SCH patients in Brazil. Materials and methods: After structuring the clinical questions, the search for evidence in the literature was initially performed in the MedLine-PubMed database and later in the Embase and SciELO -Lilacs databases. The strength of evidence was evaluated according to the Oxford classification system and established based on the experimental design used, considering the best available evidence for each question and the Brazilian experience. Results: The topics covered included SCH definition and diagnosis, natural history, clinical significance, treatment and pregnancy, and the consensus issued 29 recommendations for the clinical management of adult patients with SCH. Conclusion: Treatment with levothyroxine was recommended for all patients with persistent SCH with serum TSH values ≥ 10 mU/L and for certain patient subgroups. Arq Bras Endocrinol Metab. 2013;57(3):166-83

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Section: When Should Sch Be Treated?mentioning

confidence: 99%

Consenso brasileiro para a abordagem clínica e tratamento do hipotireoidismo subclínico em adultos: recomendações do Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia

Sgarbi

Teixeira

Maciel

et al. 2013

Arq Bras Endocrinol Metab

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“…The prevalence of subclinical hyperthyroidism ranges from 1 to 15% and of subclinical hypothyroidism from 3 to 16% in individuals aged 60 years and older (1). Although overt thyroid disorders do negatively influence physical and cognitive function (2), associations of subclinical thyroid disorders with these outcome measures are less clear and studies demonstrate contradictory results (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). A systematic review of the literature rated the evidence as insufficient to confirm or refute an association of subclinical thyroid disorders with clinical symptoms (2).…”

Section: Introductionmentioning

confidence: 99%

Endogenous subclinical thyroid disorders, physical and cognitive function, depression, and mortality in older individuals

Jongh

Lips

Schoor

et al. 2011

European Journal of Endocrinology

133

108

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Objective: To what extent endogenous subclinical thyroid disorders contribute to impaired physical and cognitive function, depression, and mortality in older individuals remains a matter of debate. Design: A population-based, prospective cohort of the Longitudinal Aging Study Amsterdam. Methods: TSH and, if necessary, thyroxine and triiodothyronine levels were measured in individuals aged 65 years or older. Participants were classified according to clinical categories of thyroid function. Participants with overt thyroid disease or use of thyroid medication were excluded, leaving 1219 participants for analyses. Outcome measures were physical and cognitive function, depressive symptoms (cross-sectional), and mortality (longitudinal) Results: Sixty-four (5.3%) individuals had subclinical hypothyroidism and 34 (2.8%) individuals had subclinical hyperthyroidism. Compared with euthyroidism (nZ1121), subclinical hypo-, and hyperthyroidism were not significantly associated with impairment of physical or cognitive function, or depression. On the contrary, participants with subclinical hypothyroidism did less often report more than one activity limitation (odds ratio 0.44, 95% confidence interval (CI) 0.22-0.86). After a median follow-up of 10.7 years, 601 participants were deceased. Subclinical hypo-and hyper-thyroidism were not associated with increased overall mortality risk (hazard ratio 0.89, 95% CI 0.59-1.35 and 0.69, 95% CI 0.40-1.20 respectively). Conclusions: This study does not support disadvantageous effects of subclinical thyroid disorders on physical or cognitive function, depression, or mortality in an older population.

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“…Some studies mention specific effects (Baldini et al, 1997(Baldini et al, , 2009Bono et al, 2004;Jenšovský et al, 2000Jenšovský et al, , 2002Monzani et al, 1993;), other works do not prove positive changes (e.g. Parle et al, 2010). Recent study by Jorde et al (2006) does not either demonstrate the profit of T4 treatment, but it does not find any differences among patients with subclinical hypothyroidism, concerning the health status, as well as by Vigário et al (2009), Park et al (2010.…”

Section: Researches In Subclinical Hypothyroidism and Hyperthyroidismmentioning

confidence: 93%

Psychosocial Factors in Patients with Thyroid Disease

Mandincová¹

2012

Thyroid and Parathyroid Diseases - New Insights Into Some Old and Some New Issues

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A Randomized Controlled Trial of the Effect of Thyroxine Replacement on Cognitive Function in Community-Living Elderly Subjects with Subclinical Hypothyroidism: The Birmingham Elderly Thyroid Study

Abstract: This RCT provides no evidence for treating elderly subjects with SCH with T4 replacement therapy to improve cognitive function.

Cited by 156 publications

References 33 publications

Consenso brasileiro para a abordagem clínica e tratamento do hipotireoidismo subclínico em adultos: recomendações do Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia

Consenso brasileiro para a abordagem clínica e tratamento do hipotireoidismo subclínico em adultos: recomendações do Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia

Endogenous subclinical thyroid disorders, physical and cognitive function, depression, and mortality in older individuals

Psychosocial Factors in Patients with Thyroid Disease

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