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Does treatment withl-thyroxine influence health status in middle-aged and older adults with subclinical hypothyroidism?

Journal of General Internal Medicine volume 11, pages 744–749 (1996)Cite this article

Abstract

OBJECTIVE: To determine if health-related quality of life (HRQL) in patients of middle age and older with elevated thyroid-stimulating hormone (TSH) and normal total thyroid hormone levels—subclinical hypothyroidism—improves withl-thyroxine replacement therapy.

DESIGN: Randomized, double-blind, placebo-controlled trial.

SETTING: Outpatient clinic.

PATIENTS: Thirty-seven patients with subclinical hypothyroidism, most with symptoms consistent with hypothyroidism, over 55 years of age.

INTERVEJVTIOJVS: Placebo or L-thyroxine replacement therapy to achieve normal TSH level.

MEASUREMENTS AND MAIN RESULTS: Disease-specific and general HRQL, cognitive function, bone mineral density, lipid levels. The mean daily dose of L-thyroxine replacement in the active group was 68±21 µg. TSH decreased by 8.6 mIU/L (95% confidence interval [CI] 4.1 to 13.1) and T4 increased by 27.9 nmol/L (95% CI 14.8 to 41.2). There was a statistically significant improvement in a composite psychometric memory score in treated versus control patients; all other outcomes showed similar findings in the two groups. Although confidence intervals for most measures did not exclude an important improvement in HRQL with thyroid replacement, no measure of symptoms or HRQL either showed clinically important trends in favor of treatment, or approached conventional levels of statistical significance.

CONCLUSIONS: In middle-aged and older patients with elevated TSH and normal T4, it may not be harmful to follow biochemical and clinical status even in the presence of nonspecific symptoms potentially associated with hypothyroidism.

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Affiliations

  1. the Department of Medicine, McMaster University, Canada

    Roman Jaeschke MD, MSc, Gordon Guyatt MD, MSc, Hertzel Gerstein MD, MSc, Christopher Patterson MD, William Molloy MB & Deborah Cook MD, MSc

  2. the Department of Clinical Epidemiology and Biostatistics, McMaster University, Canada

    Gordon Guyatt MD, MSc, Deborah Cook MD, MSc & Lauren Griffith MSc

  3. the Department of Psychiatry, McMaster University, Canada

    Ramona Carbotte PhD

  4. Department of Medicine, St. Joseph’s Hospital, Hamilton, Ontario, Canada

    Roman Jaeschke MD, MSc & Deborah Cook MD, MSc

Authors
  1. Roman Jaeschke MD, MSc
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  2. Gordon Guyatt MD, MSc
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  3. Hertzel Gerstein MD, MSc
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  4. Christopher Patterson MD
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  5. William Molloy MB
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  6. Deborah Cook MD, MSc
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  7. Sandra Harper
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  8. Lauren Griffith MSc
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  9. Ramona Carbotte PhD
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Additional information

Supported by a grant from Ontario Ministry of Health and by a grant from Boots Pharmaceuticals. Medication and placebo was provided by Boots Pharmaceuticals.

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Jaeschke, R., Guyatt, G., Gerstein, H. et al. Does treatment withl-thyroxine influence health status in middle-aged and older adults with subclinical hypothyroidism?. J Gen Intern Med 11, 744–749 (1996). https://doi.org/10.1007/BF02598988

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  • DOI: https://doi.org/10.1007/BF02598988

Key words

  • Subclinical hypothyroidism
  • quality of life
  • elderly