Sommige patienten met levothyroxine houden symptomen ondanks normale waarden

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ineke
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Lid geworden op: 08 nov 2014, 17:53

Sommige patienten met levothyroxine houden symptomen ondanks normale waarden

Bericht door ineke »

Informatie via de Endocrine Society vanuit de gehouden bijeenkomst Maart 2018 in Chicago


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Studie-onderzoek LifeLines door Hanneke Wouters UMCG (Groningen)
Some patients on levothyroxine continue to experience symptoms despite normal thyroid hormone levels

CHICAGO —
Adults with hypothyroidism prescribed levothyroxine were more likely to experience lower health-related quality of life and increased comorbidities when compared with similar adults not prescribed thyroid hormone therapy, according to study data presented here.

“Hypothyroidism is a common endocrine disorder, and substitution therapy with levothyroxine is the standard of care,” Hanneke Wouters, BSc, of University Medical Center Groningen, Netherlands, said during an oral abstract presentation at the Endocrine Society Annual Meeting.
“Unfortunately, about 10% of the individuals using this drug continue to experience symptoms and a disturbed wellbeing and a disturbed quality of life, despite the fact that their [thyroid-stimulating hormone] level is within the normal range, so they are euthyroid.”


Wouters and colleagues analyzed data from 34,400 adults with thyroid function measurements participating in the population-based Dutch Lifelines cohort.
Participants self-reported medical history and medication use and completed the RAND-36 short form health survey, with domains on physical functioning, social functioning, physical and emotional role limitations, mental health, vitality, bodily pain and general health (scores ranged from 0-100 in each domain).

Researchers assessed mean scores for each domain and the percentage of participants who scored below a predetermined, sex-specific cutoff value. Comorbidities were defined as medication use other than levothyroxine and oral contraceptives, or a medical history of diseases for which medication is not always prescribed, such as migraines. Logistic regression analysis was used to assess the association between levothyroxine use health-related quality-of-life scores and comorbidities.


Within the cohort, 995 adults (2.8% of total cohort) were prescribed levothyroxine.
Compared with the population not prescribed levothyroxine, these patients were more likely to be women (89.4% vs. 57.9%), older (mean age, 51 years vs. 45 years), have higher BMI (mean, 27.2 kg/m² vs. 26.1 kg/m²) and use more medications (range, 0-4 vs. 0-2). Patients prescribed levothyroxine were also more likely to have a comorbidity vs. those not prescribed the drug (80.6% vs. 66%).

Among those prescribed levothyroxine, 60% had a normal thyroid-stimulating hormone level (0.4-4 mU/L), 13.4% had TSH defined as suppressed (< 0.4 mU/L) and 26.6% had elevated TSH (at least 4 mU/L), Wouters said. Among patients not using levothyroxine, 89% had normal TSH measurements, she said.

“Since we had these large differences in main characteristics, we decided to match our euthyroid [levothyroxine] users 1:5 with peers from the general population for these variables,” Wouters said.
In comparing the euthyroid levothyroxine users (n = 573) with matched adults not using levothyroxine (n = 2,859), researchers observed that TSH levels between the two groups were similar (mean, 1.9 mU/L vs. 2.1 mU/L); however, mean FT4 for the euthyroid levothyroxine group was higher (18.5 vs. 15.6 pmol/L) whereas mean FT3 level was lower (4.6 vs. 5.1 pmol/L), Wouters said.


Origineel:
https://www.healio.com/endocrinology/th ... thyroidism

of via
https://www.endocrine.org/news-room/201 ... one-levels





Wederom een onderzoek over ouderen en schildlierhormoonwaarden gepresenteerd op
de gehouden bijeenkomst in Chicago.


Levothyroxine therapy may increase risk for death in older adults

In older adults with subclinical hypothyroidism, levothyroxine therapy increases the risk for death from any cause, according to study data presented here.

“It is uncertain whether subclinical hypothyroidism should be treated with levothyroxine, particularly in the elderly,” Joseph Meyerovitch, MD, of the National Center for Childhood Diabetes at Schneider Children’s Hospital in Ramat Hasharon, Israel, and colleagues wrote in an abstract presented at the Endocrine Society Annual Meeting. “This study evaluated the association between levothyroxine treatment and mortality in adults [aged] 65 years or older with subclinical hypothyroidism and [thyroid-stimulating hormone] values less than 10 mIU/L.”

In a case-control study, Meyerovitch and colleagues analyzed data from 419 adults aged at least 65 years without overt thyroid disease who had TSH level between 4.2 and 10 mIU/L and who died between 2012 and 2016, and 1,558 similar adults who did not die (controls), matched based on age, sex, comorbidities, date of TSH screening, duration of follow-up and TSH quartile. Researchers compared levothyroxine use between the two groups.

In multivariable analysis, researchers found that older adults prescribed levothyroxine treatment were 19% more likely to die of any cause vs. controls (HR = 1.19; 95% CI, 1.03-1.38). There were no between-group differences in femoral fractures or incidence of atrial fibrillation following the initiation of levothyroxine therapy, according to researchers.

Other factors associated with mortality included age, dementia status, congestive heart failure, cerebrovascular disease and renal failure, the researchers noted.

“Physicians should consider the results of the study before they begin treatment with levothyroxine in individuals [aged] 65 years and [older] who have subclinical hypothyroidism and TSH values under 10 mIU/L,” the researchers said in a press release.

Origineel
https://www.healio.com/endocrinology/th ... der-adults

of via
https://www.endocrine.org/news-room/201 ... -mortality

Dit is het onderzoek (abstract) > tegen betaling volledig te lezen;
http://www.ejinme.com/article/S0953-620 ... 5/fulltext


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