New Research Questions Traditional Treatments for Thyroid Disorders

Yet another study has found that treating thyroid disorders is not as straightforward as once thought. The latest research by Joseph Meyerovitch, MD, of Schneider Medical Center, Ramat Hasharon, Israel has shown that treating borderline low thyroid levels is associated with increased risk for death in people over the age of 65 years. The death rate was 19% higher in patients taking levothyroxine, according to an analysis by Dr. Meyerovitch. The study also found a dramatically increased risk for dementia, heart failure, chronic renal failure, and cerebrovascular disease in the patients who took thyroid hormone. The research was presented at the 2018 meeting of the Endocrine Society in Chicago.

The current recommendation is that physicians should reevaluate giving elderly patients levothyroxine to treat mild thyroid disorders until more information is available. Other studies have shown a similar effect of treating subclinical hypothyroidism in the elderly.

A study published in the New England Journal of Medicine in June 2017 known as the TRUST study (Thyroid Hormone Replacement for Subclinical Hypothyroidism) found that treatment with thyroid hormone did not provide any improvement in hypothyroid symptoms. The researchers found that there was a benefit in some symptoms, but this was no different than the improvement seen with a placebo. Patients reported improvement in thyroid-specific quality of life symptoms but the extent to which they improved was no different whether someone took a placebo or real thyroid medication. 

The TSH level naturally rises as a person matures, especially after the age of 65. A TSH level of 5-10 mIU/L can be normal for someone over the age of 65 and is frequently seen in patients over the age of 80. Treatment of a mildly elevated TSH in this population may not be helpful. Furthermore, studies have shown that people with a higher TSH level over the age of 65 tend to live longer. We need less thyroid hormone as we mature and the elevation of TSH as we age is not harmful and may even have a protective effect.

The bottom line is that we have a lot more to learn about treating thyroid disease, especially in people over the age of 65. Research has shown that there are some treatments that don’t seem to provide any benefit beyond that of a placebo. But, my experience, the real world is infinitely different than in a clinical trial. In my experience, with careful adjustment of doses of thyroid hormone, different brands or with trying different thyroid hormone preparations including liothyronine (Cytomel) and natural desiccated thyroid hormone (Armour thyroid, Nature-throid, NP Thyroid and others) most patients feel better. It is not a one size fits all approach as was done in these studies. The way you feel is just as important as your thyroid hormone levels.

Author
Scott Isaacs, MD Endocrinologist and Weight Loss Specialist

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