Impact of Thyroid Hormone Therapy on Atherosclerosis in the Elderly with Subclinical Hypothyroidism: A Randomized Trial.

Blum, Manuel R; Gencer, Baris; Adam, Luise; Feller, Martin; Collet, Tinh-Hai; Da Costa, Bruno R; Moutzouri, Elisavet; Dopheide, Jörn; Depairon, Michèle; Sykiotis, Gerasimos P; Kearney, Patricia; Gussekloo, Jacobijn; Westendorp, Rudi; Stott, David J; Bauer, Douglas C; Rodondi, Nicolas (2018). Impact of Thyroid Hormone Therapy on Atherosclerosis in the Elderly with Subclinical Hypothyroidism: A Randomized Trial. The Journal of clinical endocrinology and metabolism, 103(8), pp. 2988-2997. The Endocrine Society 10.1210/jc.2018-00279

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Context Subclinical hypothyroidism (SHypo) has been associated with atherosclerosis, but no conclusive clinical trials assessing the levothyroxine impact on carotid atherosclerosis exist. Objective To assess the impact of treatment of SHypo with levothyroxine on carotid atherosclerosis. Design/Setting Randomized, double-blind, placebo-controlled trial nested within the TRUST trial. Participants Participants aged ≥65 years with SHypo (thyroid-stimulating hormone, TSH, 4.60-19.99 mIU/L; free thyroxine level within reference range). Intervention Levothyroxine dose-titrated to achieve TSH normalization, or placebo including mock titrations. Main Outcome Measures Carotid intima media thickness (CIMT), maximum plaque thickness measured with ultrasound. Results 185 participants (mean age 74.1 years, 47% women, 96 randomized to levothyroxine) underwent carotid ultrasound. Overall mean TSH±SD was 6.35±1.95 mIU/L at baseline and decreased to 3.55±2.14 mIU/L with levothyroxine, as compared to 5.29±2.21 mIU/L with placebo (p<0.001). After a median treatment of 18.4 months (interquartile range 12.2-30.0 months), mean CIMT was 0.85±0.14 mm under levothyroxine and 0.82±0.13 mm under placebo (between-group difference=0.02 mm, 95% confidence interval (CI)-0.01 to 0.06, p=0.30). Proportion of carotid plaque was similar (n=135, 70.8% under levothyroxine and 75.3% under placebo, p=0.46). Maximum carotid plaque thickness was 2.38±0.92 mm under levothyroxine and 2.37±0.91 mm under placebo (between-group difference -0.03, 95%CI -0.34 to 0.29, p=0.86). There were no significant interactions between levothyroxine treatment and mean CIMT according to sex, baseline TSH (categories 4.6-6.9, 7.0-9.9, and ≥10mmol/L) or established cardiovascular disease (all p for interaction ≥0.14). Conclusion Normalization of TSH with levothyroxine was associated with no difference in CIMT and carotid atherosclerosis in older persons with SHypo.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology

UniBE Contributor:

Blum, Manuel; Adam, Luise Leonore; Feller, Martin; Da Costa, Bruno; Moutzouri, Elisavet and Rodondi, Nicolas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1945-7197

Publisher:

The Endocrine Society

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

12 Jun 2018 11:19

Last Modified:

14 Aug 2018 14:56

Publisher DOI:

10.1210/jc.2018-00279

PubMed ID:

29846630

BORIS DOI:

10.7892/boris.117158

URI:

https://boris.unibe.ch/id/eprint/117158

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