Chicago—Patients with hypothyroidism who are undertreated with a thyroid hormone replacement face a greater risk of unfavorable hospital outcomes, including an extended length of stay and higher readmission rates.

According to a recent study published in the Endocrine Society's Journal of Clinical Endocrinology and Metabolism, the University of Chicago–led researchers report that patients with a high thyroid-stimulating hormone (TSH) level before hospitalization had a length of stay that was 1.2 days longer, a 49% higher risk of 30-day readmission, and a 43% higher rate of 90-day readmission compared with patients without hypothyroidism.

Finding the right balance of treatment can be challenging, noted lead author, Matthew D. Ettleson, MD. "We found that those patients who were undertreated with thyroid hormone, even weeks or months prior to hospital admission, had worse hospital outcomes than those without hypothyroidism. This has not been shown previously."

Of the 43,478 patients from a large, U.S.-based patient claims database included in the study, 8,873 had hypothyroidism. Patients were divided into four groups based on their levels of TSH. The groups were: low (TSH <0.40 mIU/L), normal (TSH 0.40-4.50 mIU/L), intermediate (TSH 4.51-10.00 mIU/L), and high (TSH >10.00 mIU/L).

A low level of TSH indicates that a patient has been overtreated for their thyroid disease, while a high level of TSH corresponds to undertreatment.

The study found that patients with a normal TSH level before hospitalization had a decreased risk of dying in the hospital and a decreased 90-day readmission rate compared with patients without hypothyroidism.

Comparatively, those with a high prehospitalization TSH level had a length of stay that was 1.2 days longer (95% CI 1.1-1.3; P = .003), a 49% higher risk of 30-day readmission (RR 1.49, 95% CI 1.20-1.85; P <.001), and a 43% higher rate of 90-day readmission (RR 1.43, 95% CI 1.21-1.67; P <.001) compared with balanced controls. Patients with normal TSH levels exhibited a decreased risk of in-hospital mortality (RR 0.46, 95% CI 0.27-0.79;   = .004) and 90-day readmission (RR 0.92, 95% CI 0.85-0.99; P = .02).

"The results suggest that suboptimal treatment of hypothyroidism is associated with worse hospital outcomes," Dr. Ettleson explained. "It is important for both patients and physicians to know that maintaining optimal thyroid hormone replacement is important to minimize length of hospital stays and hospital readmission. It is particularly important for planned admissions where thyroid hormone replacement can be adjusted if needed prior to admission."

Dr. Ettleson will present the research at ENDO 2022, the Endocrine Society's annual meeting, in Atlanta on Saturday, June 11, from 1 to 3 PM and during a Rapid-Fire Poster Presentation on Sunday, June 12, from 12:30 to 1:30 PM.

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