Leuven, Belgium—Subclinical hypothyroidism shouldn’t be routinely treated with thyroid hormones, according to an international panel of experts.

In a report in The BMJ, the global panel—led by Belgian researchers but including experts from the University of Florida, among others—made a recommendation against hormone treatment for underactive thyroid with mild symptoms. The advice was based on new evidence that medication therapy doesn’t improve quality of life, depressed mood, or fatigue.

Subclinical hypothyroidism (SCH), which occurs when levels of the thyroid stimulating hormone (TSH) are slightly raised while the level of thyroid hormone remains normal, affects about 5% of the adult population but as many as 15% of older adults. Symptoms can include fatigue, low mood, and weight gain, which may or may not be related to the condition.

Most guidelines recommend hormones for TSH levels above 10 mIU/L, while a normal TSH is in the 0.4 to 4.0 mIU/L range, and for those with lower levels who are young, symptomatic, or have specific indications for prescribing. The authors point out that hormone treatment for SCH doubled from 1996 to 2006.

While the authors write, “The guideline panel issues a strong recommendation against thyroid hormones in adults with SCH (elevated TSH levels and normal free T4 [thyroxin] levels),” they caution that the advice does not apply to women who are trying to become pregnant or patients with TSH 20 mIU/L or lower and may not be applicable to patients with severe symptoms or those age 30 years and younger.

The systematic review leading to the recommendation included 21 trials with 2,192 participants. Based on that research, the panel concluded that very few adults with SCH would benefit from treatment with thyroid hormones.

“Other factors in the strong recommendation include the burden of lifelong management and uncertainty on potential harms,” they add. “Instead, clinicians should monitor the progression or resolution of the thyroid dysfunction in these adults.”

If implemented, this recommendation “may substantially alter prescribing trends,” the panel concludes.

 « Click here to return to Weekly News Update.