Thyroid antibodies and levothyroxine effects in subclinical hypothyroidism: A pooled analysis of two randomized controlled trials.
autoimmune thyroid disease
levothyroxine treatment
subclinical hypothyroidism
Journal
Journal of internal medicine
ISSN: 1365-2796
Titre abrégé: J Intern Med
Pays: England
ID NLM: 8904841
Informations de publication
Date de publication:
12 2022
12 2022
Historique:
pubmed:
28
7
2022
medline:
10
11
2022
entrez:
27
7
2022
Statut:
ppublish
Résumé
Antithyroid antibodies increase the likelihood of developing overt hypothyroidism, but their clinical utility remains unclear. No large randomized controlled trial (RCT) has assessed whether older adults with subclinical hypothyroidism (SHypo) caused by autoimmune thyroid disease derive more benefits from levothyroxine treatment (LT4). To determine whether older adults with SHypo and positive antibodies derive more clinical benefits from LT4 than those with negative antibodies. We pooled individual participant data from two RCTs, Thyroid Hormone Replacement for Untreated Older Adults with Subclinical Hypothyroidism and IEMO 80+. Participants with persistent SHypo were randomly assigned to receive LT4 or placebo. We compared the effects of LT4 versus placebo in participants with and without anti-thyroid peroxidase (TPO) at baseline. The two primary outcomes were 1-year change in Hypothyroid Symptoms and Tiredness scores on the Thyroid-Related Quality-of-Life Patient-Reported Outcome Questionnaire. Among 660 participants (54% women) ≥65 years, 188 (28.5%) had positive anti-TPO. LT4 versus placebo on Hypothyroid Symptoms lead to an adjusted between-group difference of -2.07 (95% confidence interval: -6.04 to 1.90) for positive antibodies versus 0.89 (-1.76 to 3.54) for negative antibodies (p for interaction = 0.31). Similarly, there was no treatment effect modification by baseline antibody status for Tiredness scores-adjusted between-group difference 1.75 (-3.60 to 7.09) for positive antibodies versus 1.14 (-1.90 to 4.19) for negative antibodies (p for interaction = 0.98). Positive anti-TPO were not associated with better quality of life, improvement in handgrip strength, or fewer cardiovascular outcomes with levothyroxine treatment. Among older adults with SHypo, positive antithyroid antibodies are not associated with more benefits on clinical outcomes with LT4.
Sections du résumé
BACKGROUND
Antithyroid antibodies increase the likelihood of developing overt hypothyroidism, but their clinical utility remains unclear. No large randomized controlled trial (RCT) has assessed whether older adults with subclinical hypothyroidism (SHypo) caused by autoimmune thyroid disease derive more benefits from levothyroxine treatment (LT4).
OBJECTIVE
To determine whether older adults with SHypo and positive antibodies derive more clinical benefits from LT4 than those with negative antibodies.
METHODS
We pooled individual participant data from two RCTs, Thyroid Hormone Replacement for Untreated Older Adults with Subclinical Hypothyroidism and IEMO 80+. Participants with persistent SHypo were randomly assigned to receive LT4 or placebo. We compared the effects of LT4 versus placebo in participants with and without anti-thyroid peroxidase (TPO) at baseline. The two primary outcomes were 1-year change in Hypothyroid Symptoms and Tiredness scores on the Thyroid-Related Quality-of-Life Patient-Reported Outcome Questionnaire.
RESULTS
Among 660 participants (54% women) ≥65 years, 188 (28.5%) had positive anti-TPO. LT4 versus placebo on Hypothyroid Symptoms lead to an adjusted between-group difference of -2.07 (95% confidence interval: -6.04 to 1.90) for positive antibodies versus 0.89 (-1.76 to 3.54) for negative antibodies (p for interaction = 0.31). Similarly, there was no treatment effect modification by baseline antibody status for Tiredness scores-adjusted between-group difference 1.75 (-3.60 to 7.09) for positive antibodies versus 1.14 (-1.90 to 4.19) for negative antibodies (p for interaction = 0.98). Positive anti-TPO were not associated with better quality of life, improvement in handgrip strength, or fewer cardiovascular outcomes with levothyroxine treatment.
CONCLUSIONS
Among older adults with SHypo, positive antithyroid antibodies are not associated with more benefits on clinical outcomes with LT4.
Identifiants
pubmed: 35894851
doi: 10.1111/joim.13544
pmc: PMC9796496
doi:
Substances chimiques
Thyroxine
Q51BO43MG4
Types de publication
Meta-Analysis
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
892-903Informations de copyright
© 2022 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.
Références
BMC Endocr Disord. 2017 Feb 3;17(1):6
pubmed: 28158982
Ann Intern Med. 2020 Jun 2;172(11):709-716
pubmed: 32365355
J Clin Endocrinol Metab. 2002 Jul;87(7):3221-6
pubmed: 12107228
Am J Med. 2002 Apr 1;112(5):348-54
pubmed: 11904108
J Intern Med. 2022 Dec;292(6):892-903
pubmed: 35894851
Thyroid. 2012 Dec;22(12):1200-35
pubmed: 22954017
BMC Health Serv Res. 2020 Jan 30;20(1):70
pubmed: 32000765
J Clin Endocrinol Metab. 2007 May;92(5):1715-23
pubmed: 17299073
Eur Thyroid J. 2013 Dec;2(4):215-28
pubmed: 24783053
JAMA. 2018 Oct 2;320(13):1349-1359
pubmed: 30285179
JAMA. 2019 Nov 26;322(20):1977-1986
pubmed: 31664429
J Clin Epidemiol. 2016 Oct;78:63-72
pubmed: 27020087
Eur J Endocrinol. 2010 Jan;162(1):161-7
pubmed: 19797502
J Clin Endocrinol Metab. 2013 Sep;98(9):3584-7
pubmed: 24014812
Clin Endocrinol (Oxf). 1995 Jul;43(1):55-68
pubmed: 7641412
Qual Life Res. 2015 Mar;24(3):769-80
pubmed: 25194574
JAMA. 2010 Sep 22;304(12):1365-74
pubmed: 20858880
Autoimmun Rev. 2014 Apr-May;13(4-5):391-7
pubmed: 24434360
Thyroid. 2001 Aug;11(8):757-64
pubmed: 11525268
Clin Endocrinol (Oxf). 2005 May;62(5):580-4
pubmed: 15853828
Arch Intern Med. 2000 Feb 28;160(4):526-34
pubmed: 10695693
J Clin Endocrinol Metab. 2007 Dec;92(12):4575-82
pubmed: 17911171
N Engl J Med. 2019 Jul 11;381(2):190-191
pubmed: 31291531
N Engl J Med. 1996 Jul 11;335(2):99-107
pubmed: 8649497
Endocr Res. 2015;40(3):121-6
pubmed: 25775223
JAMA Intern Med. 2021 Oct 1;181(10):1402-1405
pubmed: 34152370
Autoimmunity. 2008 Feb;41(1):46-54
pubmed: 18176864
J Clin Endocrinol Metab. 2010 Mar;95(3):1095-104
pubmed: 20097710
J Theor Biol. 2015 Jun 21;375:95-100
pubmed: 25576242
N Engl J Med. 2017 Jun 29;376(26):2556-2565
pubmed: 28657873
N Engl J Med. 2017 Jun 29;376(26):2534-2544
pubmed: 28402245
Lancet Diabetes Endocrinol. 2017 Apr;5(4):246-248
pubmed: 28029536
N Engl J Med. 2003 Jun 26;348(26):2646-55
pubmed: 12826640
JAMA. 2019 Jul 09;322(2):153-160
pubmed: 31287527
BMJ. 2019 May 14;365:l2006
pubmed: 31088853
Health Policy. 1990 Dec;16(3):199-208
pubmed: 10109801
JAMA. 2019 Nov 26;322(20):1961-1962
pubmed: 31664455
Best Pract Res Clin Endocrinol Metab. 2019 Dec;33(6):101367
pubmed: 31812326
J Clin Endocrinol Metab. 2002 Feb;87(2):489-99
pubmed: 11836274
JAMA. 2013 Nov 27;310(20):2145-6
pubmed: 24141794
JAMA. 2004 Dec 1;292(21):2591-9
pubmed: 15572717
Thyroid. 2019 Feb;29(2):174-182
pubmed: 30501570
J Clin Endocrinol Metab. 2013 Feb;98(2):533-40
pubmed: 23162099
Clin Endocrinol (Oxf). 2006 Jan;64(1):97-104
pubmed: 16402936