Clinical Outcomes After Discontinuation of Thyroid Hormone Replacement: A Systematic Review and Meta-Analysis

Burgos, Nydia; Toloza, Freddy J.K.; Ospina, Naykky M Singh; Brito, Juan P.; Salloum, Ramzi G.; Hassett, Leslie; Maraka, Spyridoula

doi:10.1089/thy.2020.0679

Cited by 27 publications

(14 citation statements)

References 53 publications

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“…Such a TSH right shift along with an appropriately increased iodine intake has been reported recently also for thyroid-healthy children and adolescents (20). All these findings, in turn, may explain a relevant part of the current relative large number of patients treated for hypothyroidism and receiving thyroxine, although probably not requiring thyroid hormone therapy, as has to some extent been documented and discussed recently (21). In concert with this, among many non-pregnant adults treated for subclinical hypothyroidism, the use of thyroid hormone therapy has not been found to be associated with improvements in general quality of life or thyroid-related symptoms (22).…”

supporting

confidence: 66%

Why an Increase of TSH in Populations With Initially Mild-to-Moderate Iodine Deficiency Can Be Good News

Remer

2022

Front. Nutr.

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supporting

confidence: 66%

Why an Increase of TSH in Populations With Initially Mild-to-Moderate Iodine Deficiency Can Be Good News

Remer

2022

Front. Nutr.

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“…A guideline panel including patients, clinicians, and methodologists issued in 2019 a strong recommendation against thyroid hormones in adults with subclinical hypothyroidism (which may not apply to pregnant women, patients with TSH >20 mU/L, patients with severe symptoms, or young adults ≤30 years of age) [ 55 ]. Furthermore, 36% of patients with treated subclinical hypothyroidism remain euthyroid after thyroid hormone discontinuation [ 56 ]. It is thus likely that most patients who were dissatisfied with the outcome of LT4 treatment had received LT4 because of subclinical hypothyroidism, a condition that by itself poorly responds to LT4.…”

Section: Pathophysiological Explanations For Persistent Symptoms On Lt4mentioning

confidence: 99%

T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity

Wiersinga

2021

Endocrinol Metab

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Thyroxine (T4)+triiodothyronine (T3) combination therapy can be considered in case of persistent symptoms despite normal serum thyroid stimulating hormone in levothyroxine (LT4)-treated hypothyroid patients. Combination therapy has gained popularity in the last two decades, especially in countries with a relatively high gross domestic product. The prevalence of persistent symptoms has also increased; most frequent are complaints about energy levels and fatigue (80% to 90%), weight management (70% to 75%), memory (60% to 80%), and mood (40% to 50%). Pathophysiological explanations for persistent problems are unrealistic patient expectations, comorbidities, somatic symptoms, related disorders (Diagnostic and Statistical Manual of Mental Disorders [DSM-5]), autoimmune neuroinflammation, and low tissue T3. There is fair circumstantial evidence for the latter cause (tissue and specifically brain T3 content is normalized by T4+T3, not by T4 alone), but the other causes are viewed as more relevant in current practice. This might be related to the 'hype' that has emerged surrounding T4+T3 therapy. Although more and better-designed trials are needed to validate the efficacy of T4+T3 combination, the management of persistent symptoms should also be directed towards alternative causes. Improving the doctor-patient relationship and including more and better information is crucial. For example, dissatisfaction with the outcomes of T4 treatment for subclinical hypothyroidism can be anticipated as recent trials have demonstrated that LT4 is hardly effective in improving symptoms associated with subclinical hypothyroidism.

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“…There is general consensus that SCH patients with TSH concentrations of <10.00 mIU/L do not require clinical intervention ( 4 , 15 , 16 ), and that overdiagnosis could cause unnecessary psychological and economic burden. But the SCH patients with TSH concentrations of <10.00 mIU/L could develop clinical thyroid diseases every year, which means they could not be ignored and need monitoring.…”

Section: Resultsmentioning

confidence: 99%

Comparison of Five Different Criteria for Diagnosis of Subclinical Hypothyroidism in a Large-Scale Chinese Population

et al. 2022

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BackgroundSeveral different criteria for subclinical hypothyroidism (SCH) have been used in the literature, but the performance of these criteria was unknown.ObjectiveThis retrospective study was to evaluate the diagnostic criteria for SCH.MethodsEligible participants were based on centration of thyroglobulin antibodies (TG-Ab), thyroid peroxidase antibodies (TPO-Ab), and five thyroid-related hormones including total thyroxine (TT4), total triiodothyronine (TT3), free thyroxine (FT4), free triiodothyronine (FT3), and thyroid-stimulating hormone (TSH). Euthyroid individuals were identified via specific criteria. Five different SCH diagnostic criteria were compared based on the distributions of those indicators. An appropriate TSH cut-off value was reconsidered.ResultsThe study included 145,015 participants. The number of SCH cases diagnosed using criterion 5 was significantly different compared to the cases diagnosed using criteria 1-4 (P<0.05) and had the highest positive proportions of TG-Ab and TPO-Ab. Analysis of 60,515 subjects with normal other thyroid hormones revealed a median TSH concentration of 2.04 mIU/L, and the P2.5–P97.5 CI was 0.48-7.03 mIU/L. When the threshold for TSH elevation was elevated from ≥4.5 mIU/L to ≥6.50 mIU/L, the number of diagnosed SCH cases decreased from 7.30% to 2.09% and the proportions of positive TG-Ab and TPO-Ab increased from 23.69% and 24.07% to 33.75% and 35.06%, respectively (P<0.01).ConclusionsCombination of an elevated TSH and normal TT3, TT4, FT3, and FT4 concentrations is a must for the diagnosis of SCH. A new TSH threshold should be identified for better patient monitoring and management, according to the real-world characteristics of TSH distribution in Chinese population.

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Clinical Outcomes After Discontinuation of Thyroid Hormone Replacement: A Systematic Review and Meta-Analysis

Cited by 27 publications

References 53 publications

Why an Increase of TSH in Populations With Initially Mild-to-Moderate Iodine Deficiency Can Be Good News

Why an Increase of TSH in Populations With Initially Mild-to-Moderate Iodine Deficiency Can Be Good News

T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity

Comparison of Five Different Criteria for Diagnosis of Subclinical Hypothyroidism in a Large-Scale Chinese Population

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