Effect of Thyroid Hormone Therapy on Fatigability in Older Adults With Subclinical Hypothyroidism: A Nested Study Within a Randomized Placebo-Controlled Trial.

Stuber, Mirah J.; Moutzouri, Elisavet; Feller, Martin; Del Giovane, Cinzia; Bauer, Douglas C; Blum, Manuel R.; Collet, Tinh-Hai; Gussekloo, Jacobijn; Mooijaart, Simon P; McCarthy, Vera J C; Aujesky, Drahomir; Westendorp, Rudi; Stott, David J; Glynn, Nancy W; Kearney, Patricia M; Rodondi, Nicolas (2020). Effect of Thyroid Hormone Therapy on Fatigability in Older Adults With Subclinical Hypothyroidism: A Nested Study Within a Randomized Placebo-Controlled Trial. Journals of gerontology. Series A - biological sciences and medical sciences, 75(9), e89-e94. Oxford University Press 10.1093/gerona/glaa123

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BACKGROUND

Fatigue often triggers screening for and treatment of subclinical hypothyroidism. However, data on the impact of levothyroxine on fatigue is limited and previous studies might not have captured all aspects of fatigue.

METHOD

This study is nested within the randomized, placebo-controlled, multicenter TRUST trial, including community-dwelling participants aged ≥65 and older, with persistent subclinical hypothyroidism (TSH 4.60-19.99 mIU/L, normal free thyroxine levels) from Switzerland and Ireland. Interventions consisted of daily levothyroxine starting with 50 μg (25 μg if weight <50 kg or known coronary heart diseases) together with dose adjustments to achieve a normal TSH and mock titration in the placebo group. Main outcome was the change in physical and mental fatigability using the Pittsburgh Fatigability Scale over 1 year, assessed through multivariable linear regression with adjustment for country, sex, and levothyroxine starting dose.

RESULTS

Among 230 participants, the mean ± standard deviation (SD) TSH was 6.2 ± 1.9 mIU/L at baseline and decreased to 3.1 ± 1.3 with LT4 (n = 119) versus 5.3 ± 2.3 with placebo (n = 111, p < .001) after 1 year. After adjustment we found no between-group difference at 1 year on perceived physical (0.2; 95% CI -1.8 to 2.1; p = .88), or mental fatigability (-1.0; 95% CI -2.8 to 0.8; p = .26). In participants with higher fatigability at baseline (≥15 points for the physical score [n = 88] or ≥13 points for the mental score [n = 41]), the adjusted between-group differences at 1 year were 0.4 (95% CI -3.6 to 2.8, p = .79) and -2.2 (95% CI -8.8 to 4.5, p = .51).

CONCLUSIONS

Levothyroxine in older adults with mild subclinical hypothyroidism provides no change in physical or mental fatigability.

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

UniBE Contributor:

Stuber, Mirah Julia; Moutzouri, Elisavet; Feller, Martin; Del Giovane, Cinzia; Blum, Manuel; Aujesky, Drahomir and Rodondi, Nicolas

Subjects:

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

ISSN:

1079-5006

Publisher:

Oxford University Press

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

30 Jun 2020 18:55

Last Modified:

18 Sep 2020 01:32

Publisher DOI:

10.1093/gerona/glaa123

PubMed ID:

32577745

Uncontrolled Keywords:

Fatigue Levothyroxine Thyroid disease

BORIS DOI:

10.7892/boris.144896

URI:

https://boris.unibe.ch/id/eprint/144896

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