Stopping levothyroxine side effects
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Stopping Levothyroxine: Managing Side Effects in Older Adults
Introduction to Levothyroxine and Its Use in Older Adults
Levothyroxine is a commonly prescribed medication for hypothyroidism, a condition where the thyroid gland does not produce enough thyroid hormone. While it is often continued for life, recent studies suggest that the necessity and safety of long-term levothyroxine use, especially in older adults, may need re-evaluation.
Risks of Overtreatment with Levothyroxine
Decreased Physical Need with Age
As people age, their physical need for levothyroxine can decrease. This reduction in need can lead to overtreatment, which poses a higher risk of adverse effects such as cardiovascular issues and other health complications1.
Lack of Benefit in Subclinical Hypothyroidism
Large trials have shown that levothyroxine may not provide significant benefits for older adults with subclinical hypothyroidism (SCH), a milder form of hypothyroidism where thyroid-stimulating hormone (TSH) levels are elevated but free thyroxine (fT4) levels remain within the normal range1 2.
Effects of Discontinuing Levothyroxine
Study on Discontinuation in Older Adults
A self-controlled trial aimed to determine the effects of discontinuing levothyroxine in older adults. Participants aged 60 and above, who had been using levothyroxine at a stable dosage, gradually discontinued the medication under medical supervision. The primary outcome was to maintain thyroid function within the reference range after discontinuation1.
Monitoring and Outcomes
Regular monitoring of thyroid function was essential during the discontinuation process. The study found that a significant proportion of participants could successfully withdraw from levothyroxine while maintaining normal thyroid function. Secondary outcomes included the impact on thyroid-specific and general health-related quality of life, as well as patients' attitudes towards stopping the medication1.
Cardiovascular Outcomes and Levothyroxine
Pooled Analysis of Randomized Controlled Trials
A pooled analysis of two randomized controlled trials investigated the cardiovascular effects of levothyroxine treatment in older adults with SCH. The trials included participants aged 65 and above, who were randomly assigned to receive either levothyroxine or a placebo2.
Findings on Cardiovascular Risks
The analysis revealed that levothyroxine treatment did not significantly alter the risk of cardiovascular events, including atrial fibrillation, heart failure, or all-cause mortality, regardless of the participants' age or history of cardiovascular disease2. This suggests that the cardiovascular risks associated with levothyroxine overtreatment may not be as significant as previously thought.
Conclusion
In conclusion, the necessity of lifelong levothyroxine treatment in older adults, particularly those with subclinical hypothyroidism, is questionable. Discontinuing levothyroxine under medical supervision can be a viable option for many older adults, potentially reducing the risk of overtreatment and its associated side effects. Regular monitoring and individualized patient care are crucial to ensure safe and effective management of thyroid function during and after discontinuation.
Sources and full results
Most relevant research papers on this topic
Effects of discontinuation of levothyroxine treatment in older adults: protocol for a self-controlled trial
Discontinuing levothyroxine treatment in older adults may lead to better thyroid function and quality of life, but requires regular monitoring by a GP.
Levothyroxine Treatment and Cardiovascular Outcomes in Older People With Subclinical Hypothyroidism: Pooled Individual Results of Two Randomised Controlled Trials
Levothyroxine treatment does not significantly change the risk of cardiovascular outcomes in older adults with subclinical hypothyroidism, regardless of a history of cardiovascular disease and age.
RCT
Large Human TrialLevothyroxine Interactions with Food and Dietary Supplements–A Systematic Review
Levothyroxine ingestion in the morning and at bedtime is equally effective, but interactions with coffee, soy products, fiber, calcium, or iron supplements can decrease its absorption.
Systematic ReviewOral levothyroxine therapy postbariatric surgery: Biopharmaceutical aspects and clinical effects.
Bariatric surgery may compromise levothyroxine absorption or decrease dose requirements, requiring close monitoring of thyroid hormone levels.
Systematic ReviewEffect of Levothyroxine on Older Patients With Subclinical Hypothyroidism: A Systematic Review and Meta-Analysis
Levothyroxine treatment may reduce cholesterol, triglycerides, LDL-C, and ApoB levels in older patients with subclinical hypothyroidism without significantly affecting other aspects of their health.
Meta-AnalysisLithium and thyroid.
Lithium may cause thyroid issues, but it can also be used as an adjunct therapy for severe hyperthyroidism and thyroiditis.
Highly CitedMedications and Food Interfering with the Bioavailability of Levothyroxine: A Systematic Review
Many medications and foods can impair the bioavailability of levothyroxine, requiring awareness and dose adjustment for optimal treatment.
Systematic ReviewComment on: Levothyrox® New and Old Formulations: Are They Switchable for Millions of Patients?
The new Levothyrox® formula in France may have increased adverse reactions due to the presence of a levothyroxine-citric acid adduct, which may not be switchable for millions of patients.
Levothyroxine Treatment and the Risk of Cardiac Arrhythmias – Focus on the Patient Submitted to Thyroid Surgery
Levothyroxine treatment can cause side-effects, including cardiac arrhythmias and osteoporosis deterioration, especially when higher doses are prescribed.
Literature ReviewThe effect of levothyroxine and selenomethionine on lymphocyte and monocyte cytokine release in women with Hashimoto's thyroiditis.
Levothyroxine and selenomethionine both exhibit a similar antiinflammatory effect in euthyroid females with Hashimoto's thyroiditis, potentially benefiting prevention and management.
RCT
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