Thyroid hormones treatment for subclinical hypothyroidism: A clinical practice guideline

G. E. Bekkering, T. Agoritsas, L. Lytvyn, A. F. Heen, M. Feller, E. Moutzouri, H. Abdulazeem, B. Aertgeerts, D. Beecher, Juan Brito Campana, P. D. Farhoumand, N. Singh Ospina, N. Rodondi, M. Van Driel, E. Wallace, M. Snel, P. M. Okwen, R. Siemieniuk, P. O. Vandvik, T. KuijpersM. Vermandere

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Clinical question What are the benefits and harms of thyroid hormones for adults with subclinical hypothyroidism (SCH)? This guideline was triggered by a recent systematic review of randomised controlled trials, which could alter practice. Current practice Current guidelines tend to recommend thyroid hormones for adults with thyroid stimulating hormone (TSH) levels >10 mIU/L and for people with lower TSH values who are young, symptomatic, or have specific indications for prescribing. Recommendation The guideline panel issues a strong recommendation against thyroid hormones in adults with SCH (elevated TSH levels and normal free T4 (thyroxine) levels). It does not apply to women who are trying to become pregnant or patients with TSH >20 mIU/L. It may not apply to patients with severe symptoms or young adults (such as those ≤30 years old). How this guideline was created A guideline panel including patients, clinicians, and methodologists produced this recommendation in adherence with standards for trustworthy guidelines using the GRADE approach. The evidence The systematic review included 21 trials with 2192 participants. For adults with SCH, thyroid hormones consistently demonstrate no clinically relevant benefits for quality of life or thyroid related symptoms, including depressive symptoms, fatigue, and body mass index (moderate to high quality evidence). Thyroid hormones may have little or no effect on cardiovascular events or mortality (low quality evidence), but harms were measured in only one trial with few events at two years' follow-up. Understanding the recommendation The panel concluded that almost all adults with SCH would not benefit from treatment with thyroid hormones. Other factors in the strong recommendation include the burden of lifelong management and uncertainty on potential harms. Instead, clinicians should monitor the progression or resolution of the thyroid dysfunction in these adults. Recommendations are made actionable for clinicians and their patients through visual overviews. These provide the relative and absolute benefits and harms of thyroid hormones in multilayered evidence summaries and decision aids available in MAGIC (https://app.magicapp.org/) to support shared decisions and adaptation of this guideline.

Original languageEnglish (US)
Article numberl2006
JournalBMJ (Online)
Volume365
DOIs
StatePublished - Jan 1 2019

Fingerprint

Hypothyroidism
Thyroid Hormones
Practice Guidelines
Guidelines
Thyrotropin
Therapeutics
Thyroid Gland
Decision Support Techniques
Thyroxine
Uncertainty
Fatigue
Young Adult
Body Mass Index
Randomized Controlled Trials
Quality of Life
Depression
Mortality

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Bekkering, G. E., Agoritsas, T., Lytvyn, L., Heen, A. F., Feller, M., Moutzouri, E., ... Vermandere, M. (2019). Thyroid hormones treatment for subclinical hypothyroidism: A clinical practice guideline. BMJ (Online), 365, [l2006]. https://doi.org/10.1136/bmj.l2006

Thyroid hormones treatment for subclinical hypothyroidism : A clinical practice guideline. / Bekkering, G. E.; Agoritsas, T.; Lytvyn, L.; Heen, A. F.; Feller, M.; Moutzouri, E.; Abdulazeem, H.; Aertgeerts, B.; Beecher, D.; Brito Campana, Juan; Farhoumand, P. D.; Singh Ospina, N.; Rodondi, N.; Van Driel, M.; Wallace, E.; Snel, M.; Okwen, P. M.; Siemieniuk, R.; Vandvik, P. O.; Kuijpers, T.; Vermandere, M.

In: BMJ (Online), Vol. 365, l2006, 01.01.2019.

Research output: Contribution to journalArticle

Bekkering, GE, Agoritsas, T, Lytvyn, L, Heen, AF, Feller, M, Moutzouri, E, Abdulazeem, H, Aertgeerts, B, Beecher, D, Brito Campana, J, Farhoumand, PD, Singh Ospina, N, Rodondi, N, Van Driel, M, Wallace, E, Snel, M, Okwen, PM, Siemieniuk, R, Vandvik, PO, Kuijpers, T & Vermandere, M 2019, 'Thyroid hormones treatment for subclinical hypothyroidism: A clinical practice guideline', BMJ (Online), vol. 365, l2006. https://doi.org/10.1136/bmj.l2006
Bekkering GE, Agoritsas T, Lytvyn L, Heen AF, Feller M, Moutzouri E et al. Thyroid hormones treatment for subclinical hypothyroidism: A clinical practice guideline. BMJ (Online). 2019 Jan 1;365. l2006. https://doi.org/10.1136/bmj.l2006
Bekkering, G. E. ; Agoritsas, T. ; Lytvyn, L. ; Heen, A. F. ; Feller, M. ; Moutzouri, E. ; Abdulazeem, H. ; Aertgeerts, B. ; Beecher, D. ; Brito Campana, Juan ; Farhoumand, P. D. ; Singh Ospina, N. ; Rodondi, N. ; Van Driel, M. ; Wallace, E. ; Snel, M. ; Okwen, P. M. ; Siemieniuk, R. ; Vandvik, P. O. ; Kuijpers, T. ; Vermandere, M. / Thyroid hormones treatment for subclinical hypothyroidism : A clinical practice guideline. In: BMJ (Online). 2019 ; Vol. 365.
@article{012303fdc8a44b57a5d73465a33d3439,
title = "Thyroid hormones treatment for subclinical hypothyroidism: A clinical practice guideline",
abstract = "Clinical question What are the benefits and harms of thyroid hormones for adults with subclinical hypothyroidism (SCH)? This guideline was triggered by a recent systematic review of randomised controlled trials, which could alter practice. Current practice Current guidelines tend to recommend thyroid hormones for adults with thyroid stimulating hormone (TSH) levels >10 mIU/L and for people with lower TSH values who are young, symptomatic, or have specific indications for prescribing. Recommendation The guideline panel issues a strong recommendation against thyroid hormones in adults with SCH (elevated TSH levels and normal free T4 (thyroxine) levels). It does not apply to women who are trying to become pregnant or patients with TSH >20 mIU/L. It may not apply to patients with severe symptoms or young adults (such as those ≤30 years old). How this guideline was created A guideline panel including patients, clinicians, and methodologists produced this recommendation in adherence with standards for trustworthy guidelines using the GRADE approach. The evidence The systematic review included 21 trials with 2192 participants. For adults with SCH, thyroid hormones consistently demonstrate no clinically relevant benefits for quality of life or thyroid related symptoms, including depressive symptoms, fatigue, and body mass index (moderate to high quality evidence). Thyroid hormones may have little or no effect on cardiovascular events or mortality (low quality evidence), but harms were measured in only one trial with few events at two years' follow-up. Understanding the recommendation The panel concluded that almost all adults with SCH would not benefit from treatment with thyroid hormones. Other factors in the strong recommendation include the burden of lifelong management and uncertainty on potential harms. Instead, clinicians should monitor the progression or resolution of the thyroid dysfunction in these adults. Recommendations are made actionable for clinicians and their patients through visual overviews. These provide the relative and absolute benefits and harms of thyroid hormones in multilayered evidence summaries and decision aids available in MAGIC (https://app.magicapp.org/) to support shared decisions and adaptation of this guideline.",
author = "Bekkering, {G. E.} and T. Agoritsas and L. Lytvyn and Heen, {A. F.} and M. Feller and E. Moutzouri and H. Abdulazeem and B. Aertgeerts and D. Beecher and {Brito Campana}, Juan and Farhoumand, {P. D.} and {Singh Ospina}, N. and N. Rodondi and {Van Driel}, M. and E. Wallace and M. Snel and Okwen, {P. M.} and R. Siemieniuk and Vandvik, {P. O.} and T. Kuijpers and M. Vermandere",
year = "2019",
month = "1",
day = "1",
doi = "10.1136/bmj.l2006",
language = "English (US)",
volume = "365",
journal = "The BMJ",
issn = "0959-8146",
publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - Thyroid hormones treatment for subclinical hypothyroidism

T2 - A clinical practice guideline

AU - Bekkering, G. E.

AU - Agoritsas, T.

AU - Lytvyn, L.

AU - Heen, A. F.

AU - Feller, M.

AU - Moutzouri, E.

AU - Abdulazeem, H.

AU - Aertgeerts, B.

AU - Beecher, D.

AU - Brito Campana, Juan

AU - Farhoumand, P. D.

AU - Singh Ospina, N.

AU - Rodondi, N.

AU - Van Driel, M.

AU - Wallace, E.

AU - Snel, M.

AU - Okwen, P. M.

AU - Siemieniuk, R.

AU - Vandvik, P. O.

AU - Kuijpers, T.

AU - Vermandere, M.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Clinical question What are the benefits and harms of thyroid hormones for adults with subclinical hypothyroidism (SCH)? This guideline was triggered by a recent systematic review of randomised controlled trials, which could alter practice. Current practice Current guidelines tend to recommend thyroid hormones for adults with thyroid stimulating hormone (TSH) levels >10 mIU/L and for people with lower TSH values who are young, symptomatic, or have specific indications for prescribing. Recommendation The guideline panel issues a strong recommendation against thyroid hormones in adults with SCH (elevated TSH levels and normal free T4 (thyroxine) levels). It does not apply to women who are trying to become pregnant or patients with TSH >20 mIU/L. It may not apply to patients with severe symptoms or young adults (such as those ≤30 years old). How this guideline was created A guideline panel including patients, clinicians, and methodologists produced this recommendation in adherence with standards for trustworthy guidelines using the GRADE approach. The evidence The systematic review included 21 trials with 2192 participants. For adults with SCH, thyroid hormones consistently demonstrate no clinically relevant benefits for quality of life or thyroid related symptoms, including depressive symptoms, fatigue, and body mass index (moderate to high quality evidence). Thyroid hormones may have little or no effect on cardiovascular events or mortality (low quality evidence), but harms were measured in only one trial with few events at two years' follow-up. Understanding the recommendation The panel concluded that almost all adults with SCH would not benefit from treatment with thyroid hormones. Other factors in the strong recommendation include the burden of lifelong management and uncertainty on potential harms. Instead, clinicians should monitor the progression or resolution of the thyroid dysfunction in these adults. Recommendations are made actionable for clinicians and their patients through visual overviews. These provide the relative and absolute benefits and harms of thyroid hormones in multilayered evidence summaries and decision aids available in MAGIC (https://app.magicapp.org/) to support shared decisions and adaptation of this guideline.

AB - Clinical question What are the benefits and harms of thyroid hormones for adults with subclinical hypothyroidism (SCH)? This guideline was triggered by a recent systematic review of randomised controlled trials, which could alter practice. Current practice Current guidelines tend to recommend thyroid hormones for adults with thyroid stimulating hormone (TSH) levels >10 mIU/L and for people with lower TSH values who are young, symptomatic, or have specific indications for prescribing. Recommendation The guideline panel issues a strong recommendation against thyroid hormones in adults with SCH (elevated TSH levels and normal free T4 (thyroxine) levels). It does not apply to women who are trying to become pregnant or patients with TSH >20 mIU/L. It may not apply to patients with severe symptoms or young adults (such as those ≤30 years old). How this guideline was created A guideline panel including patients, clinicians, and methodologists produced this recommendation in adherence with standards for trustworthy guidelines using the GRADE approach. The evidence The systematic review included 21 trials with 2192 participants. For adults with SCH, thyroid hormones consistently demonstrate no clinically relevant benefits for quality of life or thyroid related symptoms, including depressive symptoms, fatigue, and body mass index (moderate to high quality evidence). Thyroid hormones may have little or no effect on cardiovascular events or mortality (low quality evidence), but harms were measured in only one trial with few events at two years' follow-up. Understanding the recommendation The panel concluded that almost all adults with SCH would not benefit from treatment with thyroid hormones. Other factors in the strong recommendation include the burden of lifelong management and uncertainty on potential harms. Instead, clinicians should monitor the progression or resolution of the thyroid dysfunction in these adults. Recommendations are made actionable for clinicians and their patients through visual overviews. These provide the relative and absolute benefits and harms of thyroid hormones in multilayered evidence summaries and decision aids available in MAGIC (https://app.magicapp.org/) to support shared decisions and adaptation of this guideline.

UR - http://www.scopus.com/inward/record.url?scp=85065924777&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065924777&partnerID=8YFLogxK

U2 - 10.1136/bmj.l2006

DO - 10.1136/bmj.l2006

M3 - Article

C2 - 31088853

AN - SCOPUS:85065924777

VL - 365

JO - The BMJ

JF - The BMJ

SN - 0959-8146

M1 - l2006

ER -