Patiënten met subklinische hypothyreoïdie niet gebaat bij behandeling met schildklierhormoon
Geplaatst: 12 okt 2018, 18:12
Opnieuw een onderzoek voor behandeling van subklinische hypothyreoïdie.
Patiënten met subklinische hypothyreoïdie niet gebaat bij behandeling met schildklierhormoon
9 oktober 2018 • NIEUWSBERICHT
Behandeling van subklinische hypothyreoïdie met schildklierhormoon (levothyroxine) heeft geen effect op kwaliteit van leven, BMI, bloeddruk, cognitief functioneren en vermoeidheid.
Dit schrijven LUMC-onderzoekers professor Olaf Dekkers en Marieke Snel in het vooraanstaande tijdschrift JAMA.
Op dit moment is het advies in de huidige internationale en nationale richtlijnen om patiënten met subklinische hypothyreoïdie en daarbij lichamelijke en/of psychische klachten een proefbehandeling met schildklierhormoonsubstitutie aan te bieden.
In de meta-analyse van Dekkers en Snel werden gegevens van 21 gerandomiseerde onderzoeken gebruikt waarin levothyroxine met placebo werd vergeleken zonder waarneembaar effect op kwaliteit van leven, cognitief functioneren of BMI.
Deze meta-analyse ondersteunt dan ook niet dat er routinematig gestart dient te worden met schildklierhormoon- subtitutietherapie bij patiënten met subklinische hypothyreoïdie.
U kunt het volledige artikel over het onderzoek naar subklinische hypothyreoïdie lezen op de website van JAMA.
Bron: LUMC
Abstract artikel in JAMA:
Association of Thyroid Hormone Therapy With Quality of Life and Thyroid-Related Symptoms in Patients With Subclinical Hypothyroidism
A Systematic Review and Meta-analysis
Martin Feller, MD, MSc1,2,3; Marieke Snel, MD, PhD3; Elisavet Moutzouri, MD, PhD1,2; et al Douglas C. Bauer, MD4; Maria de Montmollin, MD1,2; Drahomir Aujesky, MD, MSc1; Ian Ford, PhD5; Jacobijn Gussekloo, MD, PhD3,6; Patricia M. Kearney, MD, PhD, MPH7; Simon Mooijaart, MD, PhD3,8; Terry Quinn, MD9; David Stott, MD9; Rudi Westendorp, MD, PhD10; Nicolas Rodondi, MD, MAS1,2; Olaf M. Dekkers, MD, MA, MSc, PhD3,11,12
JAMA. 2018;320(13):1349-1359. doi:10.1001/jama.2018.13770
Key Points
Question
Among patients with subclinical hypothyroidism, is the use of thyroid hormone therapy associated with improvements in general quality of life or thyroid-related symptoms?
Findings
In this meta-analysis of 21 randomized clinical trials including 2192 participants with subclinical hypothyroidism, thyroid hormone therapy was not significantly associated with improvements in general quality of life (standardized mean difference, −0.11) or thyroid-related symptoms (standardized mean difference, 0.01).
Meaning
These findings do not support the routine use of thyroid hormone therapy in adults with subclinical hypothyroidism.
Abstract
Importance
The benefit of thyroid hormone therapy for subclinical hypothyroidism is uncertain. New evidence from recent large randomized clinical trials warrants an update of previous meta-analyses.
Objective
To conduct a meta-analysis of the association of thyroid hormone therapy with quality of life and thyroid-related symptoms in adults with subclinical hypothyroidism.
Data Sources
PubMed, EMBASE, ClinicalTrials.gov, Web of Science, Cochrane Library, CENTRAL, Emcare, and Academic Search Premier from inception until July 4, 2018.
Study Selection
Randomized clinical trials that compared thyroid hormone therapy with placebo or no therapy in nonpregnant adults with subclinical hypothyroidism were eligible.
Two reviewers independently evaluated eligibility based on titles and abstracts of all retrieved studies.
Studies not excluded in this first step were independently assessed for inclusion after full-text evaluation by 2 reviewers.
Data Extraction and Synthesis
Two independent reviewers extracted data, assessed risk of bias (Cochrane risk-of-bias tool), and evaluated the quality of evidence (GRADE tool).
For synthesis, differences in clinical scores were transformed (eg, quality of life) into standardized mean differences (SMDs; positive values indicate benefit of thyroid hormone therapy; 0.2, 0.5, and 0.8 correspond to small, moderate, and large effects, respectively).
Random-effects models for meta-analyses were applied.
Main Outcomes and Measures
General quality of life and thyroid-related symptoms after a minimum follow-up of 3 months.
Results
Overall, 21 of 3088 initially identified publications met the inclusion criteria, with 2192 adults randomized.
After treatment (range, 3-18 months), thyroid hormone therapy was associated with lowering the mean thyrotropin value into the normal reference range compared with placebo (range, 0.5-3.7 mIU/L vs 4.6 to 14.7 mIU/L) but was not associated with benefit regarding general quality of life (n = 796; SMD, −0.11; 95% CI, −0.25 to 0.03; I2=66.7%) or thyroid-related symptoms (n = 858; SMD, 0.01; 95% CI, −0.12 to 0.14; I2=0.0%).
Overall, risk of bias was low and the quality of evidence assessed with the GRADE tool was judged moderate to high.
Conclusions and Relevance
Among nonpregnant adults with subclinical hypothyroidism, the use of thyroid hormone therapy was not associated with improvements in general quality of life or thyroid-related symptoms.
These findings do not support the routine use of thyroid hormone therapy in adults with subclinical hypothyroidism.
Bron:
https://jamanetwork.com/journals/jama/a ... ultClick=1
.
Patiënten met subklinische hypothyreoïdie niet gebaat bij behandeling met schildklierhormoon
9 oktober 2018 • NIEUWSBERICHT
Behandeling van subklinische hypothyreoïdie met schildklierhormoon (levothyroxine) heeft geen effect op kwaliteit van leven, BMI, bloeddruk, cognitief functioneren en vermoeidheid.
Dit schrijven LUMC-onderzoekers professor Olaf Dekkers en Marieke Snel in het vooraanstaande tijdschrift JAMA.
Op dit moment is het advies in de huidige internationale en nationale richtlijnen om patiënten met subklinische hypothyreoïdie en daarbij lichamelijke en/of psychische klachten een proefbehandeling met schildklierhormoonsubstitutie aan te bieden.
In de meta-analyse van Dekkers en Snel werden gegevens van 21 gerandomiseerde onderzoeken gebruikt waarin levothyroxine met placebo werd vergeleken zonder waarneembaar effect op kwaliteit van leven, cognitief functioneren of BMI.
Deze meta-analyse ondersteunt dan ook niet dat er routinematig gestart dient te worden met schildklierhormoon- subtitutietherapie bij patiënten met subklinische hypothyreoïdie.
U kunt het volledige artikel over het onderzoek naar subklinische hypothyreoïdie lezen op de website van JAMA.
Bron: LUMC
Abstract artikel in JAMA:
Association of Thyroid Hormone Therapy With Quality of Life and Thyroid-Related Symptoms in Patients With Subclinical Hypothyroidism
A Systematic Review and Meta-analysis
Martin Feller, MD, MSc1,2,3; Marieke Snel, MD, PhD3; Elisavet Moutzouri, MD, PhD1,2; et al Douglas C. Bauer, MD4; Maria de Montmollin, MD1,2; Drahomir Aujesky, MD, MSc1; Ian Ford, PhD5; Jacobijn Gussekloo, MD, PhD3,6; Patricia M. Kearney, MD, PhD, MPH7; Simon Mooijaart, MD, PhD3,8; Terry Quinn, MD9; David Stott, MD9; Rudi Westendorp, MD, PhD10; Nicolas Rodondi, MD, MAS1,2; Olaf M. Dekkers, MD, MA, MSc, PhD3,11,12
JAMA. 2018;320(13):1349-1359. doi:10.1001/jama.2018.13770
Key Points
Question
Among patients with subclinical hypothyroidism, is the use of thyroid hormone therapy associated with improvements in general quality of life or thyroid-related symptoms?
Findings
In this meta-analysis of 21 randomized clinical trials including 2192 participants with subclinical hypothyroidism, thyroid hormone therapy was not significantly associated with improvements in general quality of life (standardized mean difference, −0.11) or thyroid-related symptoms (standardized mean difference, 0.01).
Meaning
These findings do not support the routine use of thyroid hormone therapy in adults with subclinical hypothyroidism.
Abstract
Importance
The benefit of thyroid hormone therapy for subclinical hypothyroidism is uncertain. New evidence from recent large randomized clinical trials warrants an update of previous meta-analyses.
Objective
To conduct a meta-analysis of the association of thyroid hormone therapy with quality of life and thyroid-related symptoms in adults with subclinical hypothyroidism.
Data Sources
PubMed, EMBASE, ClinicalTrials.gov, Web of Science, Cochrane Library, CENTRAL, Emcare, and Academic Search Premier from inception until July 4, 2018.
Study Selection
Randomized clinical trials that compared thyroid hormone therapy with placebo or no therapy in nonpregnant adults with subclinical hypothyroidism were eligible.
Two reviewers independently evaluated eligibility based on titles and abstracts of all retrieved studies.
Studies not excluded in this first step were independently assessed for inclusion after full-text evaluation by 2 reviewers.
Data Extraction and Synthesis
Two independent reviewers extracted data, assessed risk of bias (Cochrane risk-of-bias tool), and evaluated the quality of evidence (GRADE tool).
For synthesis, differences in clinical scores were transformed (eg, quality of life) into standardized mean differences (SMDs; positive values indicate benefit of thyroid hormone therapy; 0.2, 0.5, and 0.8 correspond to small, moderate, and large effects, respectively).
Random-effects models for meta-analyses were applied.
Main Outcomes and Measures
General quality of life and thyroid-related symptoms after a minimum follow-up of 3 months.
Results
Overall, 21 of 3088 initially identified publications met the inclusion criteria, with 2192 adults randomized.
After treatment (range, 3-18 months), thyroid hormone therapy was associated with lowering the mean thyrotropin value into the normal reference range compared with placebo (range, 0.5-3.7 mIU/L vs 4.6 to 14.7 mIU/L) but was not associated with benefit regarding general quality of life (n = 796; SMD, −0.11; 95% CI, −0.25 to 0.03; I2=66.7%) or thyroid-related symptoms (n = 858; SMD, 0.01; 95% CI, −0.12 to 0.14; I2=0.0%).
Overall, risk of bias was low and the quality of evidence assessed with the GRADE tool was judged moderate to high.
Conclusions and Relevance
Among nonpregnant adults with subclinical hypothyroidism, the use of thyroid hormone therapy was not associated with improvements in general quality of life or thyroid-related symptoms.
These findings do not support the routine use of thyroid hormone therapy in adults with subclinical hypothyroidism.
Bron:
https://jamanetwork.com/journals/jama/a ... ultClick=1
.