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By Amy Orciari Herman
Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM
Adults with subclinical hypothyroidism should not be treated with thyroid hormones, according to a new guideline from The BMJ's Rapid Recommendations panel.
The recommendation, characterized as "strong," applies to those with elevated thyroid-stimulating hormone levels (but still below 20 mIU/L) plus normal thyroxine levels noted on two or more consecutive tests. Patients may or may not have mild-to-moderate symptoms.
The recommendation was driven by data from a 2018 meta-analysis, plus a large 2017 trial of treatment in elders (see NEJM Journal Watch coverage at links below). The panel concluded that there are "no important benefits from treatment," while the possibility of treatment harms — including a potentially higher mortality risk — could not be excluded.
The guideline does not apply to women who are attempting a pregnancy. Additionally, it may not apply to those with severe symptoms or adults aged 30 and younger.
Comment
LINK(S):
The BMJ Rapid Recommendations article (Free)
Background: NEJM Journal Watch General Medicine & NEJM Journal Watch Psychiatry coverage of 2018 meta-analysis (Your NEJM Journal Watch registration required)
Background: NEJM Journal Watch General Medicine coverage of 2017 trial in elders (Your NEJM Journal Watch registration required)