Association of Thyroid Hormone Therapy With Quality of Life and Thyroid-Related Symptoms in Patients With Subclinical Hypothyroidism

[MMaud]

Has anyone here read, and/or, reviewed the following paper?

I haven't read it myself yet, and it may take me a while to work through it as my knowledge of thyroid matters, whilst growing, could still safely be called embryonic!

jamanetwork.com/journals/ja...

I'll get there though.

[greygoose]

It's really not worth the effort, because they don't tell you what they were taking, nor how much. And, you wouldn't expect to find much improvement in QOL after 3-18 months! More false science.

[helvella Administrator Thyroid UK]

First define subclinical hypothyroidism. Then define thyroid-related symptoms. And Quality of Life.

Having done that, wonder why there were only 2192 patients in a total of 21 studies. That is only just over 100 patients per study.

And consider what appears to be the end-point of just being in TSH range.

[Hidden]

This research article has been picked up and summarised in the BMJ (BMJ 2018;363:k4154) essentially advising that there’s no evidence of benefits of levothyroxine in people presenting with sub clinical hypothyroidism.

“Thyroid hormone therapy is not associated with improvements in thyroid related symptoms or general quality of life in adults with subclinical hypothyroidism, a systematic review and meta-analysis has found.

Subclinical hypothyroidism, defined as elevated thyrotropin in combination with normal range free thyroxine, is relatively common, with a higher prevalence in women and older people. It is often treated with thyroid hormones (levothyroxine), particularly when patients have symptoms such as tiredness potentially attributable to hypothyroidism, but evidence of clinical benefit has …”

I wonder how this will effect the way people with symptoms but TSH under the threshold get treated in general practice. Hope it doesn’t throw another obstacle in people’s path to getting help.

[MMaud]

Many, many thanks folks. I'm very used to reading studies and papers for other endocrine related conditions, but just getting to grips with the thyroid "stuff", terms and all that.

In any of these articles the data collection and criteria definitions are key, else they're utterly useless.

To be honest, Hidden , the investigation of potential thyroid issues and onward management (whether treatment or a decent ignoring) is so hit and miss it's hard to believe there are protocols in place at all.

I appreciate that Endocrinology is a very wide specialism, covering large and important aspects of our bodily functions and wellbeing, but I have been shocked to my core by the ambivalence of some of those alleged "specialists".

This latest response for me was probably more shocking that the boredom exhibited when, I saw a rheumatologist, on the back of a Consultant (Endo) >Consultant(Rheuma) referral. I have actually never seen anyone so disinterested, who still had a pulse.

Her examination of me was to hold my hands out for signs of RA (she declared I had mild OA, but I wasn't there to assess anything to do with arthritis), and feeling the temperature of my hands which she dismissed as cold "because it was winter".

Frankly, she was lucky to live. It took me quite some weeks to get over what frankly felt like a waste of everyone's time, money and verging on abuse. OK; abuse might be a bit strong, but I was not impressed.

Anyway. Rant over. We move on. Knowledge is power.