Is Standard Hypothyroidism Treatment Inadequate?
In patients with hypothyroidism, standard treatment does not always control all aspects of the condition, according to the results of a recent analysis.1
Currently, the standard of care for hypothyroidism is levothyroxine given in doses that normalize serum thyroid signaling hormone (TSH) levels.
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In order to determine whether this approach universally restores TSH, researchers conducted a review of studies involving patients with hypothyroidism were treated with levothyroxine to normalize serum TSH that also measured other markers of thyroid hormone signaling (serum low-density lipoprotein (LDL), total cholesterol (TC), sex hormone-binding globulin (SHBG), creatine kinase and/or ferritin levels; cognition, energy expenditure, and/or renal function).
Overall, 99 studies met inclusion criteria. The researchers found that patients treated with levothyroxine who had normal serum TSH levels had 3.31 ± 1.64 mg/dL higher serum LDL levels and 9.60 ± 3.55 mg/dL higher serum TC levels compared to controls. In studies that did not concomitantly assess healthy controls, serum LDL levels were 138.3 ± 4.6 mg/dL and serum TC levels were 209.6 ± 3.4 mg/dL.
“In studies that utilized levothyroxine monotherapy at doses that normalized the serum TSH for overt, primary hypothyroidism, not all systemic biological markers of thyroid hormone signaling were normalized, including serum LDL and TC levels,” the researchers concluded.
—Michael Potts
Reference:
McAninch EA, Rajan KB, Miller CH, Bianco AC. Systemic thyroid hormone status during levothyroxine therapy in hypothyroidism: a systematic review and meta-analysis [published online August 15, 2018]. The Journal of Clinical Endocrinology & Metabolism. doi.org/10.1210/jc.2018-01361.