T4 supplements in subclinical hypothyroidism do not have significant effects on cardiac performance in older people

[diogenes]

This paper shows that T4 supplementation in older adults with subclinical hypothyroidism has no effect on future cardiovascular events. It thus does no harm and therefore does not justify any alarm that T4 in SCH has any bad effect at all ages. So If a dctor says that no therapy will be given in SCH (TSH 5-10), because of potential heart effects, this paper denies it.

Levothyroxine Treatment and Cardiovascular Outcomes in Older People With Subclinical Hypothyroidism: Pooled Individual Results of Two Randomised Controlled Trials

May 2021Frontiers in Endocrinology 12:674841 Follow journal

DOI: 10.3389/fendo.2021.674841

Laurien Zijlstra, J Wouter, Jukema Rudi, G. J. Westendorp , Simon P Mooijaart et al

Abstract and figures

Background The cardiovascular effects of treating older adults with subclinical hypothyroidism (SCH) are uncertain. Although concerns have been raised regarding a potential increase in cardiovascular side effects from thyroid hormone replacement, undertreatment may also increase the risk of cardiovascular events, especially for patients with cardiovascular disease (CVD). Objective To determine the effects of levothyroxine treatment on cardiovascular outcomes in older adults with SCH. Methods Combined data of two parallel randomised double-blind placebo-controlled trials TRUST (Thyroid hormone Replacement for Untreated older adults with Subclinical hypothyroidism – a randomised placebo controlled Trial) and IEMO80+ (the Institute for Evidence-Based Medicine in Old Age 80-plus thyroid trial) were analysed as one-stage individual participant data. Participants aged ≥65 years for TRUST (n=737) and ≥80 years for IEMO80+ (n=105) with SCH, defined by elevated TSH with fT4 within the reference range, were included. Participants were randomly assigned to receive placebo or levothyroxine, with titration of the dose until TSH level was within the reference range. Cardiovascular events and cardiovascular side effects of overtreatment (new-onset atrial fibrillation and heart failure) were investigated, including stratified analyses according to CVD history and age. Results The median [IQR] age was 75.0 [69.7–81.1] years, and 448 participants (53.2%) were women. The mean TSH was 6.38± SD 5.7 mIU/L at baseline and decreased at 1 year to 5.66 ± 3.3 mIU/L in the placebo group, compared with 3.66 ± 2.1 mIU/L in the levothyroxine group (p<0.001), at a median dose of 50 μg. Levothyroxine did not significantly change the risk of any of the prespecified cardiovascular outcomes, including cardiovascular events (HR 0.74 [0.41–1.25]), atrial fibrillation (HR 0.69 [0.32–1.52]), or heart failure (0.41 [0.13–1.35]), or all-cause mortality (HR 1.28 [0.54–3.03]), irrespective of history of CVD and age. Conclusion Treatment with levothyroxine did not significantly change the risk of cardiovascular outcomes in older adults with subclinical hypothyroidism, irrespective of a history of cardiovascular disease and age. Clinical Trial Registration [ ClinicalTrials.gov ], identifier [NCT01660126] (TRUST); Netherlands Trial Register: NTR3851 (IEMO80+).

[tattybogle]

Thankyou .

[Musicmonkey]

That's an important article for so many. Thanks for sharing diogenes

[Charlie-Farley]

Another one for my dossier - thank you so much diogenes.

[shaws Administrator]

Thank you diogenes for important information.

[jgelliss]

Thank you Diogenes for another great and informative post. I'm just curious if your thoughts agree with these papers?

[diogenes Remembering in reply to jgelliss]

Generally yes! I believe a) that, away from direct T3 dosing, FT3 levels should not alter much day to day either when healthy or on T4 only. and b) everyone should be considered an individual and not a statistic when it comes to diagnosing and treating.

[jgelliss in reply to diogenes]

Thank You so much Diogenes for validating many of our thoughts and feelings and your relentless hard work on our behalf. It's Great to have you as our Pilot. Blessings .

[humanbean]

A link for the full paper is here :

frontiersin.org/articles/10...