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People Increasingly Prescribed Levothyroxine for Subclinical Hypothyroidism — Physician’s First Watch
People Increasingly Prescribed Levothyroxine for Subclinical Hypothyroidism
By Kelly Young
Prescriptions for levothyroxine have increased markedly since 2002, and many people are potentially being overtreated for subclinical hypothyroidism, according to a JAMA Internal Medicine study.
U.K. researchers retrospectively assessed thyrotropin levels among some 52,000 people who began taking levothyroxine between 2001 and 2009. During that time, new prescriptions increased 1.74-fold. The median thyrotropin level at treatment initiation fell from 8.7 to 7.9 mIU/L, partly reflecting an increase in patients treated at 4.0 to 10.0 mIU/L. (Guidelines recommend considering treatment at 10.0 mIU/L or lower in those with hypothyroidism symptoms, cardiovascular disease, or other factors.)
Five years after levothyroxine initiation, 5.8% of patients had suppressed thyrotropin levels and 10.2% had low levels.
The authors conclude: "While thyroidologists are still debating whether subclinical hypothyroidism should be more widely treated, it is increasingly apparent that this is already happening in primary care. Randomized controlled trials ... are urgently needed to refine current levothyroxine prescribing and to indicate the balance of risks and benefits of current practice."