Association of Thyroid Hormone Therapy With Quality of Life and Thyroid-Related Symptoms in Patients With Subclinical Hypothyroidism

Abstract

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.

Reporting of financial conflicts of interest in meta-analyses of drug trials published in high-impact medical journals: comparison of results from 2017 to 2018 and 2009

“…As shown in Tables 1 and 2 of 29 (6.9%) included metaanalyses, both published in specialty journals [34,43], reported receiving pharmaceutical industry funding, 11 (37.9%) reported non-industry funding [23, 26, 29-32, 35, 40, 49-51], 3 reported no study funding (10.3%) [28,33,46], and the funding source of 13 (44.8%) was not reported [24, 25, 27, 36-39, 41, 42, 44, 45, 47, 48]. Meta-analysis funding sources were reported for 8 of 11 meta-analyses from general medicine journals (72.7%) [23,26,[28][29][30][31][32][33], 5 of 15 (33.3%) from specialty medicine journals [34,35,40,43,46], and all 3 (100%) Cochrane reviews [49][50][51].…”

“…As shown in Table 3, 13 of 29 (44.8%) meta-analyses reported the funding sources of included RCTs; 12 reported for all included RCTs [23,24,26,27,29,30,32,34,45,[49][50][51], whereas 1 reported for 5 of 7 included RCTs [39]. Funding sources of included RCTs were reported for 7 of 11 (63.6%) meta-analyses from general medicine journals [23,24,26,27,29,30,32], 3 of 15 (20.0%) from specialty medicine journals [34,39,45], and for all 3 (100%) Cochrane reviews [49][50][51]. The mean, median, and range of the number of RCTs in meta-analyses that reported trial funding sources were 52.9, 13, and from 2 to 522, respectively.…”

Thyroid hormone therapy does not improve symptoms in subclinical hypothyroidism, review finds

“…The results, reported in JAMA ,1 showed that thyroid hormone therapy (for 3-18 months) was associated with reducing the mean thyrotropin value into the normal reference range when compared with placebo (range 0.5-3.7 mIU/L v 4.6-14.7 mIU/L). But no improvement was found in thyroid related symptoms or quality of life.…”

Use of tests in UK primary care

“…Thyroid function tests, included as part of the Quality and Outcomes Framework, saw a 7.1% average annual increase over the study period 2. A proportion of people tested will receive a diagnosis of subclinical hypothyroidism,7 which is often treated with thyroid hormones, especially when it co-occurs with symptoms potentially attributable to hypothyroidism, such as fatigue and weight gain 8. A recent systematic review and meta-analysis of 21 randomised controlled trials, however, reported that thyroid hormone treatment was not statistically significantly associated with improvements in quality of life or thyroid related symptoms for people with subclinical hypothyroidism 7.…”

“…A proportion of people tested will receive a diagnosis of subclinical hypothyroidism,7 which is often treated with thyroid hormones, especially when it co-occurs with symptoms potentially attributable to hypothyroidism, such as fatigue and weight gain 8. A recent systematic review and meta-analysis of 21 randomised controlled trials, however, reported that thyroid hormone treatment was not statistically significantly associated with improvements in quality of life or thyroid related symptoms for people with subclinical hypothyroidism 7. This is an example of overmedicalisation, where a patient might be treated for a laboratory abnormality without clinical benefit but with attendant risks of side effects as well as the practical inconvenience.…”