Subclinical hypothyroidism: new trials, old caveats.

Details

Serval ID
serval:BIB_368C50B10967
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Subclinical hypothyroidism: new trials, old caveats.
Journal
Hormones
Author(s)
Lamine F., De Giorgi S., Marino L., Michalaki M., Sykiotis G.P.
ISSN
2520-8721 (Electronic)
ISSN-L
1109-3099
Publication state
Published
Issued date
06/2018
Peer-reviewed
Oui
Volume
17
Number
2
Pages
231-236
Language
english
Notes
Publication types: Journal Article ; Review
Publication Status: ppublish
Abstract
The indications for levothyroxine replacement therapy for subclinical hypothyroidism (SH) remain a subject of debate, especially when prescribed for older adults. The results of the recent TRUST trial indicate that levothyroxine does not improve clinical symptom scores among elderly patients with SH. While there is much concern regarding the dilemma of introducing or withholding levothyroxine, less attention may be paid to the differential diagnosis of an elevated TSH level, which is the prerequisite for diagnosing SH. Herein, we review these issues facing endocrinologists and internists/generalists either in practice or in training. When a patient presents abnormal thyroid test results compatible with SH, a series of issues need to be addressed before the implementation of replacement therapy is considered: first, an isolated TSH elevation not linked to a primary thyroid pathology should be excluded; second, the persistent nature of the patient's TSH elevation and SH profile should be verified; third, SH symptoms and potential complications relevant for the specific patient should be documented; fourth, expectations from levothyroxine substitution therapy for SH in the specific patient should be clarified. Only then can the decision be made whether levothyroxine substitution should be introduced or not.
Keywords
Hormone Replacement Therapy/standards, Humans, Hypothyroidism/diagnosis, Hypothyroidism/drug therapy, Practice Guidelines as Topic, Thyroxine/therapeutic use, Guidelines, Personalized medicine, Subclinical hypothyroidism, TRUST
Pubmed
Web of science
Open Access
Yes
Create date
15/06/2018 16:58
Last modification date
20/08/2019 13:24
Usage data