Thyroid antibodies and levothyroxine effects in subclinical hypothyroidism: A pooled analysis of two randomized controlled trials.

Lyko, Christina; Blum, Manuel R; Abolhassani, Nazanin; Stuber, Mirah J; Del Giovane, Cinzia; Feller, Martin; Moutzouri, Elisavet; Oberle, Jolanda; Jungo, Katharina T; Collet, Tinh-Hai; den Elzen, Wendy P J; Poortvliet, Rosalinde K E; Du Puy, Robert S; Dekkers, Olaf M; Trompet, Stella; Jukema, J Wouter; Aujesky, Drahomir; Quinn, Terry; Westendorp, Rudi; Kearney, Patricia M; ... (2022). Thyroid antibodies and levothyroxine effects in subclinical hypothyroidism: A pooled analysis of two randomized controlled trials. Journal of internal medicine, 292(6), pp. 892-903. Wiley 10.1111/joim.13544

[img]
Preview
Text
Lyko_JInternMed_2022.pdf - Published Version
Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works (CC-BY-NC-ND).

Download (776kB) | Preview

BACKGROUND

Antithyroid antibodies increase the likelihood of developing overt hypothyroidism, but their clinical utility remains unclear. No large randomized controlled trial (RCT) has assessed whether older adults with subclinical hypothyroidism (SHypo) caused by autoimmune thyroid disease derive more benefits from levothyroxine treatment (LT4).

OBJECTIVE

To determine whether older adults with SHypo and positive antibodies derive more clinical benefits from LT4 than those with negative antibodies.

METHODS

We pooled individual participant data from two RCTs, Thyroid Hormone Replacement for Untreated Older Adults with Subclinical Hypothyroidism and IEMO 80+. Participants with persistent SHypo were randomly assigned to receive LT4 or placebo. We compared the effects of LT4 versus placebo in participants with and without anti-thyroid peroxidase (TPO) at baseline. The two primary outcomes were 1-year change in Hypothyroid Symptoms and Tiredness scores on the Thyroid-Related Quality-of-Life Patient-Reported Outcome Questionnaire.

RESULTS

Among 660 participants (54% women) ≥65 years, 188 (28.5%) had positive anti-TPO. LT4 versus placebo on Hypothyroid Symptoms lead to an adjusted between-group difference of -2.07 (95% confidence interval: -6.04 to 1.90) for positive antibodies versus 0.89 (-1.76 to 3.54) for negative antibodies (p for interaction = 0.31). Similarly, there was no treatment effect modification by baseline antibody status for Tiredness scores-adjusted between-group difference 1.75 (-3.60 to 7.09) for positive antibodies versus 1.14 (-1.90 to 4.19) for negative antibodies (p for interaction = 0.98). Positive anti-TPO were not associated with better quality of life, improvement in handgrip strength, or fewer cardiovascular outcomes with levothyroxine treatment.

CONCLUSIONS

Among older adults with SHypo, positive antithyroid antibodies are not associated with more benefits on clinical outcomes with LT4.

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:

Lyko, Christina Valérie; Blum, Manuel; Abolhassani, Nazanin; Stuber, Mirah Julia; Del Giovane, Cinzia; Feller, Martin; Moutzouri Beifuss, Elisavet; Oberle, Jolanda; Jungo, Katharina Tabea; Aujesky, Drahomir; Bauer, Douglas Charles and Rodondi, Nicolas

Subjects:

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

ISSN:

1365-2796

Publisher:

Wiley

Language:

English

Submitter:

Pubmed Import

Date Deposited:

29 Jul 2022 15:56

Last Modified:

05 Dec 2022 16:22

Publisher DOI:

10.1111/joim.13544

PubMed ID:

35894851

Additional Information:

Lyko and Blum contributed equally to this work (co-first authors).
Open Access Funding provided by University of Bern.

Uncontrolled Keywords:

autoimmune thyroid disease levothyroxine treatment subclinical hypothyroidism

BORIS DOI:

10.48350/171590

URI:

https://boris.unibe.ch/id/eprint/171590

Actions (login required)

Edit item Edit item
Provide Feedback