The Society for Endocrinology & British Thyroid Association have just issued statement against new treatment recommendations for subclinical hypothyroidism, published in the British Medical Journal.
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Society for Endocrinology & British Thyroid Association issue statement against new treatment recommendations for subclinical hypothyroidism
The Society for Endocrinology (SfE) and British Thyroid Association (BTA) have issued a statement challenging recommendations made in a clinical practice guideline on managing subclinical hypothyroidism (SCH), published recently in the BMJ. Both SfE and BTA disagree with the conclusion that most adults with SCH do not require treatment, as the guideline does not provide sufficient evidence, especially in younger individuals, to support this claim.
Subclinical hypothyroidism affects 4-20% of the adult population but approximately one third of patients experience no symptoms. Others report symptoms characteristic of hypothyroidism, including tiredness, weight gain, feeling the cold, muscle cramps and depression. Hypothyroidism and SCH are the result of reduced activity of the thyroid gland, which produces insufficient levels of hormones important for regulating the body’s metabolic function. Hypothyroidism is usually treated by taking daily hormone replacement tablets; however, there is some debate on the appropriate hormone level thresholds that should be used for diagnosis and treatment of SCH. The new BMJ guideline recommends a threshold for SCH treatment that SfE and BTA do not believe is supported by the data, and is far too stringent.
As outlined in the SfE and BTA statement, both disagree with the strong conclusion: “The panel concluded that almost all adults with SCH would not benefit from treatment with thyroid hormones.”
Due to over-extrapolation from available data, most of which is from older patients with milder symptoms or from small-scale studies, the conclusions drawn are not justified. SfE and BTA are concerned that these recommendations could influence primary care physicians to dismiss patients with subclinical hypothyroidism, particularly younger ones, which could lead to some missing out on vital treatment if their condition progresses. SfE and BTA urge that larger studies, using more sensitive measures and taking factors, such as age and genetics, into consideration are needed before drawing such strong conclusions on the benefits or disadvantages of SCH treatment.
Peter Taylor, clinical senior lecturer and consultant endocrinologist at Cardiff University said, “What this detailed summary of the data does show is the urgent need for clinical trials of symptomatic patients with subclinical hypothyroidism especially in younger individuals.”
Onyebuchi Okosieme, consultant endocrinologist at Cardiff University School of Medicine said, “It is difficult to justify denying treatment to patients with fairly advanced degrees of subclinical hypothyroidism (TSH levels of 10-20 mU/L), as recommended by these guidelines. Many of such patients will have intrinsic thyroid disease and withholding treatment puts them at risk of disease complications.”
READ THIS! CCG's are stopping docs and endos's prescribing T3 by using bits from this that suit them. T3 is a possible treatment etc AGH!!!
What is subclinical hypothyroidism?
Updated Consensus on Liothyronine
