Small Changes in Thyroxine Dosage Do Not Produce Measurable Changes in Hypothyroid Symptoms, Well-Being, or Quality of Life: Results of a Double-Blind, Randomized Clinical Trial

Walsh, John P.; Ward, Lynley; Burke, Valerie; Bhagat, C.I.; Shiels, Lauren; Henley, David; Gillett, Melissa J; Gilbert, R D; Tanner, M.; Stuckey, Bronwyn

doi:10.1210/jc.2006-0099

Cited by 138 publications

(86 citation statements)

References 25 publications

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“…For example, a study on the starting dose of L-T 4 in newly diagnosed hypothyroidism found a faster normalization of thyroid parameters with a high starting dose of L-T 4 compared with an incremental dose regimen, but did not find a faster improvement of QOL (30). Two studies on the influence of small changes in L-T 4 doses, and thus TH levels, could not find changes in well-being, hypothyroid symptoms, or QOL (15,31). Our findings could have consequences for clinical practice as more than often L-T 4 dosages are adjusted based on the suggested relationship of patient complaints about QOL and TH levels just within or outside the normal reference range.…”

Section: Discussionmentioning

confidence: 99%

Quality of life in patients with primary hypothyroidism related to BMI

Kelderman-Bolk

Visser

Tijssen

et al. 2015

European Journal of Endocrinology

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Objective: Many patients treated for primary hypothyroidism have an unexplained reduced quality of life (QOL). We studied the relation between QOL and various parameters in treated hypothyroid patients. Design and methods: QOL analysis was done in 90 consecutive patients (77.8% females) treated for primary hypothyroidism. QOL was measured by the questionnaires Short-Form 36, Hospital Anxiety and Depression Scale and MFI20. Post hoc analysis was performed on the relation of QOL at baseline and BMI, thyroid hormones and other serum values. QOL in patients was also compared to the general population. Results: QOL was decreased compared to the general population. We found an inverse relationship between QOL and BMI. A relationship between QOL and serum thyroid parameters or auto-antibodies could not be found. Higher sex hormone binding globulin (SHBG) levels corresponded with a better QOL, which is explained by the negative association of SHBG with body weight and BMI. Conclusions: A decreased QOL in hypothyroid patients on thyroxine treatment is related to a higher body weight (BMI). Weight gain needs more attention in the treatment of hypothyroidism.

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Section: Discussionmentioning

confidence: 99%

Quality of life in patients with primary hypothyroidism related to BMI

Kelderman-Bolk

Visser

Tijssen

et al. 2015

European Journal of Endocrinology

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“…However, it is not clear that targeting the lower end of the TSH reference range will achieve patients' desired outcomes. The observational literature is divergent, and there is only one controlled trial addressing this, which did not show significant effects (11,(22)(23)(24)(25)(26)(27)(28).…”

Section: Introductionmentioning

confidence: 99%

Effect of Thyroid Function Variations Within the Laboratory Reference Range on Health Status, Mood, and Cognition in Levothyroxine-Treated Subjects

Samuels

Kolobova

Smeraglio

et al. 2016

Thyroid

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Background: There has been recent debate within the thyroid field regarding whether current upper limits of the thyrotropin (TSH) reference range should be lowered. This debate can be better informed by investigation of whether variations in thyroid function within the reference range have clinical effects. One important target organ for thyroid hormone is the brain, but little is known about variations in neurocognitive measures within the reference range for thyroid function.Methods: This was a cross-sectional study of 132 otherwise healthy hypothyroid subjects receiving chronic replacement therapy with levothyroxine (LT4) who had TSH levels across the full span of the laboratory reference range (0.34-5.6 mU/L). Subjects underwent detailed tests of health status, mood, and cognitive function, with an emphasis on memory and executive functions. Results: Subjects with low-normal (£2.5 mU/L) and high-normal (>2.5 mU/L) TSH levels did not differ on most tests of health status, mood, or cognitive function, and there were no correlations between TSH, free T4, or free T3 levels and most outcomes. There was, however, a suggestion that thyroid function affected performance on the Iowa Gambling Task, which mimics real life decision-making. Subjects with low-normal TSH levels made more advantageous decisions than those with high-normal TSH levels. Conclusions: Variations in thyroid function within the laboratory reference range do not appear to have clinically relevant effects on health status, mood, or memory in LT4 treated subjects. However, decision making, which encompasses many executive functions, may be affected. Unless further studies strengthen this finding, these data do not support narrowing the TSH reference range.

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“…Так, в ра бо те J.P. Walsh и со авт. [24] на зна че ние не сколь ко боль шей до зы L T 4 спо соб ст-во ва ло за ко но мер но умень ше нию ТТГ, а так же сни-же нию уров ня об ще го хо ле с те ри на (ОХС) у жен щин с ги по ти ре о зом. Од на ко на се го дняш ний день нет до ста точ ных ос но ва ний ре ко мен до вать всем па ци ен-там на зна че ние за ме с ти тель ной до зы L T 4 , обес пе чи-ва ю щей уро вень ТТГ в ниж нем ди а па зо не зна че ний.…”

Section: ис то рия за ме с ти тель ной те ра пии ги по ти ре о заunclassified

Лечение Первичного Гипотиреоза: Нерешенные Вопросы

et al. 2015

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Первичный гипотиреоз является одним из наиболее распространенных эндокринных заболеваний. По современным пред-ставлениям, лечение манифестного гипотиреоза подразумевает назначение заместительной монотерапии левотироксином (L-T 4 ), что обеспечивает поддержание компенсации заболевания. Достижение компенсации в подавляющем большинстве случаев приводит к нормализации самочувствия больных, купированию симптомов гипотиреоза и, как следствие, повыше-нию качества жизни. Однако, по данным разных авторов, у 5-10% пациентов с гипотиреозом, получающих L-T 4 , сохраня-ются сниженное настроение, повышенные уровни тревожности и депрессии, несмотря на поддержание стойко нормального уровня ТТГ. В обзоре обсуждаются подходы к ведению таких пациентов и как один из вариантов -перевод на комбиниро-ванную терапию левотироксином и трийодтиронином (L-T 4 +T 3 ). Клю че вые сло ва: первичный гипотиреоз, заместительная терапия, аутоиммунный тиреоидит, болезнь Грейвса, левотироксин, трийодтиронин.Primary hypothyroidism is one of the most common endocrine disorders. According to modern concepts, replacement monotherapy with levothyroxine (L-T 4 ) is the treatment of choice in primary hypothyroidism. In most cases, compensation of hypothyroidism leads to relief of symptoms and, as a consequence, improvement the quality of life. However, according to different authors, 5-10% of patients with hypothyroidism receiving adequate replacement therapy with L-T 4 have persistent symptoms of hypothyroidism, increased levels of anxiety and depression. The review discusses approaches to managing of such patients, and as one of the options -transfer to combination therapy with levothyroxine and triiodothyronine (L-T 4 +T 3 ).

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Small Changes in Thyroxine Dosage Do Not Produce Measurable Changes in Hypothyroid Symptoms, Well-Being, or Quality of Life: Results of a Double-Blind, Randomized Clinical Trial

Cited by 138 publications

References 25 publications

Quality of life in patients with primary hypothyroidism related to BMI

Quality of life in patients with primary hypothyroidism related to BMI

Effect of Thyroid Function Variations Within the Laboratory Reference Range on Health Status, Mood, and Cognition in Levothyroxine-Treated Subjects

Лечение Первичного Гипотиреоза: Нерешенные Вопросы

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