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Lookup NU author(s): Dr Salman RazviORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2025 The Author(s). Published by Oxford University Press on behalf of the Endocrine Society.Context Thyrotropin (TSH) levels tend to rise with age, but standard reference intervals do not reflect this, potentially leading to overdiagnosis of subclinical hypothyroidism (SCH) and excessive levothyroxine (LT4) prescriptions in older adults. Objective This work aimed to compare outcomes in adults older than 50 years with SCH who were either prescribed or not prescribed LT4. Methods A retrospective cohort study was conducted using data from UK Primary Care patients from the Health Improvement Network. The primary outcome was cardiovascular (CV) events (angina, myocardial infarction, peripheral vascular disease, stent procedures, or stroke). Secondary outcomes included bone events (fragility fractures or osteoporosis) and all-cause mortality. Time-varying hazard ratios (HRs) adjusted for relevant factors were estimated. Results This study included 53 899 patients (baseline median age 67 years (interquartile range [IQR]: 59-76 years); 68.5% female; median TSH 4.6 mU/L (IQR: 4.1-5.4 mU/L). Median follow-up duration was 10 years (IQR: 5.5-10.0 years). Of these, 19 952 (37%) received LT4 and 33 947 (63%) did not. LT4 therapy showed a protective effect against CV events (HR: 0.91; 95% CI, 0.87-0.97; P <. 001) but increased risk of bone events (HR: 1.21; 95% CI, 1.14-1.28; P <. 001) and all-cause mortality (HR: 1.17; 95% CI, 1.13-1.22; P <. 001). Conclusion Our data suggest that LT4 therapy in older individuals with SCH is associated with a trade-off between the potentially beneficial effect on CV risk and the deleterious relationship with bone health and mortality risk. These risks need to be considered, mitigated, and discussed when LT4 therapy is being deliberated in older patients with SCH.
Author(s): Holley M, Razvi S, Maxwell I, Dew R, Wilkes S
Publication type: Article
Publication status: Published
Journal: Journal of Clinical Endocrinology and Metabolism
Year: 2025
Volume: 110
Issue: 12
Pages: e4137-e4143
Print publication date: 01/12/2025
Online publication date: 03/04/2025
Acceptance date: 30/03/2025
Date deposited: 01/12/2025
ISSN (print): 0021-972X
ISSN (electronic): 1945-7197
Publisher: Endocrine Society
URL: https://doi.org/10.1210/clinem/dgaf208
DOI: 10.1210/clinem/dgaf208
Data Access Statement: The data that support the findings of this study are available from THIN, a wholly owned subsidiary of Cegedim SA, which owns the proprietary rights to THIN data. Restrictions apply to the availability of these data, which were used under license for the present study and are not publicly available. Data are, however, available from the authors on reasonable request and with the permission of THIN
PubMed id: 40179252
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