Falling Threshold for Treatment of Borderline Elevated Thyrotropin Levels—Balancing Benefits and Risks: Evidence From a Large Community-Based Study
Open accessAbstract
IMPORTANCE: Rates of thyroid hormone prescribing in the United States and the United Kingdom have increased substantially. If some of the increase is due to lowering the thyrotropin threshold for treatment, this may result in less benefit and greater harm. OBJECTIVE: To define trends in thyrotropin levels at the initiation of levothyroxine sodium therapy and the risk of developing a suppressed thyrotropin level following treatment. DESIGN, SETTING, PARTICIPANTS, AND EXPOSURE: Retrospective cohort study using data from the United Kingdom Clinical Practice Research Datalink. Among 52,298 individuals who received a prescription for levothyroxine between January 1, 2001, and October 30, 2009, we extracted data about the thyrotropin level before levothyroxine therapy initiation, clinical symptoms, and thyrotropin levels up to 5 years after levothyroxine was initiated. We excluded persons who had a history of hyperthyroidism, pituitary disease, or thyroid surgery; those who were taking thyroid-altering medication or if the levothyroxine prescription was related to pregnancy; and those who did not have a thyrotropin level measured within 3 months before the initiation of levothyroxine. MAIN OUTCOMES AND MEASURES: The median thyrotropin level at the time of the index levothyroxine prescription, the odds of initiation of levothyroxine therapy at thyrotropin levels of 10.0 mIU/L or less, and the age-stratified odds of developing a low or suppressed thyrotropin level after levothyroxine therapy. RESULTS: Between 2001 and 2009, the median thyrotropin level at the initiation of levothyroxine therapy fell from 8.7 to 7.9 mIU/L. The odds ratio for prescribing levothyroxine at thyrotropin levels of 10.0 mIU/L or less in 2009 compared with 2001 (adjusted for changes in population demographics) was 1.30 (95% CI, 1.19-1.42; P < .001). Older individuals and individuals with cardiac risk factors had higher odds of initiation of levothyroxine therapy with a thyrotropin level 10.0 mIU/L or less. At 5 years after levothyroxine initiation, 5.8% of individuals had a thyrotropin level of <0.1 mIU/L. Individuals with depression or tiredness at baseline had increased odds of developing a suppressed thyrotropin level, whereas individuals with cardiac risk factors (eg, atrial fibrillation, diabetes mellitus, hypertension, and raised lipid levels) did not. CONCLUSIONS AND RELEVANCE: We observed a trend toward levothyroxine treatment of more marginal degrees of hypothyroidism and a substantial risk of developing a suppressed thyrotropin level following therapy. Large-scale prospective studies are required to assess the risk-benefit ratio of current practice.
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Claims other papers make about this one
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Myxoedema is uncommon nowadays due to widespread thyroid function testing and a low threshold for initiating levothyroxine therapy.
“Myxoedema is fortunately uncommon nowadays due to widespread thyroid function testing and a low threshold for initiating levothyroxine therapy.7”
From Hypothyroidism (2024) · cites this paper as [7]
The paper’s introductory passage reports substantially increased thyroid function testing and suggests a lowering of the thyrotropin threshold for starting levothyroxine; its Results document that lower threshold. Neither passage says that myxoedema is now uncommon or that testing and treatment practices have made it uncommon. Page numbers are not available in our copy. (LLM, conf=0.83)
Experimental — accuracy not yet measuredTSH normalisation was often not attained in patients 5 years post-levothyroxine in a large population dataset; 15% of patients had a TSH concentration below the reference range and 21% had a TSH concentration above the reference range.
“TSH normalisation was often not attained in patients 5 years post-levothyroxine in a large population dataset; 15% of patients had a TSH concentration below the reference range and 21% had a TSH concentration above the reference range.7”
From Hypothyroidism (2024) · cites this paper as [7]
The ‘Thyrotropin Levels After Initiation of Levothyroxine Therapy’ section (page unavailable) supports the main point: many measured TSH levels were outside the stated ranges at five years. Its figures sum to 16.0% below 0.5 mIU/L and 21.5% above 5.0 mIU/L, rather than the cited 15% and 21%. It also notes that five-year TSH measurements were available for only 39.7% of eligible individuals. (LLM, conf=0.86)
Experimental — accuracy not yet measuredDepression is one of the most common comorbidities, accounting for persistent symptoms of ill health despite treatment of hypothyroidism.
“Depression is one of the most common comorbidities, accounting for persistent symptoms of ill health despite treatment of hypothyroidism.7”
From Hypothyroidism (2024) · cites this paper as [7]
In “Clinical Data Among Individuals Prescribed Levothyroxine” (page unavailable), depression was among the most common recorded symptoms in the 60 days before treatment, at 5.8%. The paper does not establish that depression accounts for persistent ill health despite hypothyroidism treatment; its discussion of depression at five years concerns the likelihood of overtreatment, not persistent symptoms. (LLM, conf=0.84)
Experimental — accuracy not yet measuredNine studies over nearly 30 years across five different countries show that only 50%-70% of patients prescribed levothyroxine maintain serum TSH within reference range.
“nine studies over nearly 30 years across five different countries show that only 50% -70% of patients prescribed levothyroxine maintain serum TSH within reference range. 20,30 -34”
From Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement (2023) · cites this paper as [20]
The section “Thyrotropin Levels After Initiation of Levothyroxine Therapy” reports percentages with low and elevated TSH after treatment; those figures imply that roughly 59%–63% of measured patients had TSH between 0.5 and 5.0 mIU/L at the reported time points. It does not report a synthesis of nine studies spanning nearly 30 years and five countries, and its follow-up measurements do not establish that patients maintained TSH in range continuously. No page number was provided in our copy. (LLM, conf=0.79)
Experimental — accuracy not yet measuredMost patients treated with LT4 in the last two decades had subclinical hypothyroidism (median TSH before treatment 6.8 to 7.9 mU/L).
“Epidemiological data (summarized above) demonstrate most patients treated with LT4 in the last two decades had subclinical hypothyroidism (their median TSH before treatment was 6.8 to 7.9 mU/L).”
From T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity (2021) · cites this paper as [27]
The Prescribing Patterns section reports that the annual median TSH before levothyroxine initiation fell from 8.7 to 7.9 mIU/L between 2001 and 2009, not from 6.8 to 7.9 over two decades. The Discussion reports that most patients initiated treatment with TSH at or below 10.0 mIU/L and that normal FT4 values in a measured subset were consistent with subclinical hypothyroidism, but it does not establish that most treated patients had that diagnosis. (LLM, conf=0.86)
Experimental — accuracy not yet measured
The prevalence of treated hypothyroidism has increased in the last decades, mostly due to an increase in the prevalence of treated subclinical hypothyroidism.
“We have seen an increase in the prevalence of treated hypothyroidism in the last decades, mostly due to an increase in the prevalence of treated subclinical hypothyroidism [27,28].”
From T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity (2021) · cites this paper as [27]
The Discussion reports a 1.74-fold increase in new levothyroxine prescriptions and a decline in the thyrotropin threshold for starting treatment. It does not establish that treatment of subclinical hypothyroidism accounts for most of the increase; the authors say they cannot calculate the relative contributions of increased case finding and the lower treatment threshold. Page numbers are not available in our copy. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThere is growing evidence that the TSH level when levothyroxine is initiated is steadily falling, with a median TSH value at levothyroxine prescription of around 7.0 mIU/L.
“However, there is growing evidence that the TSH level when levothyroxine is initiated is steadily falling, 7,111 with a median TSH value at levothyroxine prescription of around 7•0 mIU/L.”
From Hypothyroidism (2024) · cites this paper as [7]
The Prescribing Patterns section reports that the annual median TSH level at levothyroxine initiation fell from 8.7 to 7.9 mIU/L between 2001 and 2009. It gives an overall median of 8.2 mIU/L, not around 7.0 mIU/L. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMany patients are labelled as having hypothyroidism and started on levothyroxine inappropriately.
“This has led to many patients being labelled as having hypothyroidism and started on levothyroxine inappropriately. 20,21”
From Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement (2023) · cites this paper as [20]
The Clinical Data section reports that 10,939 patients were prescribed levothyroxine despite normal FT4 and no recorded cardiovascular risk factors or classic symptoms, describing them as potentially overtreated. The Discussion says up to 30% of recipients may lack an accepted indication. This supports concern about many potentially inappropriate prescriptions, but does not establish that all such patients were labelled as having hypothyroidism or that their treatment was definitively inappropriate. (LLM, conf=0.82)
Experimental — accuracy not yet measuredLevothyroxine has a narrow therapeutic index, and both under-treatment (TSH above reference range) and over-treatment (TSH below reference range) are common, with cross-sectional studies consistently showing that 30%-50% of patients on levothyroxine have TSH values outside of the laboratory reference range.
“Levothyroxine has a narrow therapeutic index, however, and both under -treatment (TSH above the reference range) and over -treatment (TSH below the reference range) are common, with cross -sectional studies consistently showing that 30% -50% of patients on levothyroxine have TSH values outside of the laboratory reference range. 20,30 -34,65”
From Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement (2023) · cites this paper as [20]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredLevothyroxine and liothyronine are overprescribed to people with a transient elevation in TSH.
“Both levothyroxine and liothyronine are currently overprescribed, 20,21,27 including to people with a transient elevation in TSH”
From Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement (2023) · cites this paper as [20]
The Discussion reports that 34.6% of patients started on levothyroxine for mildly elevated TSH had only one abnormal reading, and says confirmatory testing might prevent unnecessary prescriptions because some mild elevations resolve without treatment. This supports concern about prescribing levothyroxine for potentially transient elevations, but does not establish that those treated patients’ elevations were transient. Our copy does not address liothyronine prescribing. (LLM, conf=0.86)
Experimental — accuracy not yet measuredBoth levothyroxine and liothyronine are currently overprescribed.
“Both levothyroxine and liothyronine are currently overprescribed, 20,21,27 including to people with a transient elevation in TSH”
From Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement (2023) · cites this paper as [20]
The Discussion (page unavailable) says that up to 30% of people receiving levothyroxine may have been prescribed it without an accepted indication. It also notes prescriptions after only one abnormal TSH reading, supporting concern about transient elevations. The paper does not address liothyronine prescribing, so it does not support the claim about both drugs. (LLM, conf=0.90)
Experimental — accuracy not yet measuredLevothyroxine and liothyronine are overprescribed to those with persistent subclinical hypothyroidism.
“or to those with persistent subclinical hypothyroidism, where trials do not show a benefit from thyroid hormone replacement. 12,15,16,44 -46”
From Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement (2023) · cites this paper as [20]
The Discussion reports widespread levothyroxine prescribing for borderline thyrotropin levels despite limited evidence of benefit, supporting concern about unnecessary treatment. It does not address liothyronine or establish that trials show no benefit for people with persistent subclinical hypothyroidism; instead, it calls for adequately powered trials to determine the balance of benefits and risks. No page number is available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measured25-40% of patients on long-term levothyroxine treatment have a TSH concentration below or above the reference range.
“However, 25-40% of patients on long-term levothyroxine treatment have a TSH concentration below or above the reference range.7,9,10”
From Hypothyroidism (2024) · cites this paper as [7]
Suppressed TSH following levothyroxine is also more apparent if patients originally presented with depression, tiredness, or fatigue.
“Suppressed TSH following levothyroxine is also more apparent if patients originally presented with depression, tiredness, or fatigue.7”
From Hypothyroidism (2024) · cites this paper as [7]
Due to the falling TSH threshold for the initiation of levothyroxine, there has been an increasing interest in whether deprescribing levothyroxine should be considered in individuals for whom the treatment benefits might be marginal, especially in those who have been over-replaced.
“Due to the falling TSH threshold for the initiation of levothyroxine, 7 there has been an increasing interest in whether deprescribing levothyroxine should be considered in individuals for whom the treatment benefits might be marginal, especially in those who have been over-replaced.”
From Hypothyroidism (2024) · cites this paper as [7]
Many patients with subclinical hypothyroidism (TSH: 5-10 mU/L) are now treated with levothyroxine, fuelling a rise in its use, such that it is now the third most frequently prescribed medication in the United Kingdom.
“many patients with subclinical hypothyroidism (TSH: 5 -10 mU/L) are now treated with levothyroxine, 20,21 fuelling a rise in its use, such that it is now the third most frequently prescribed medication in the United Kingdom. 22”
From Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement (2023) · cites this paper as [20]
More than 30% to 50% of LT4-treated patients are estimated to be either undertreated or overtreated.
“Unfortunately, more than 30% to 50% of LT4-treated patients are estimated to be either undertreated or overtreated (45–47).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [46]
Approximately 20% of patients with primary hypothyroidism and approximately 20% or 40% of patients with central hypothyroidism are undertreated, with co-administration of interfering medications being one major cause.
“≈20% of patients with PH (10–13) and ≈20% (14) or 40% (15) of patients with CH are undertreated, co-administration of interfering medications (IM) being one major cause.”
From L-T4 therapy in the presence of pharmacological interferents (2020) · cites this paper as [13]
In the UK, Levothyroxine initiation in the elderly has progressively increased, with annual initiation rates ranging between 30 and 50 per 100,000 in individuals aged over 60 years.
“In the UK, Levothyroxine initiation in the elderly has progressively increased with annual initiation rates ranging between 30 and 50 per 100,000 in individuals aged over 60 years (Fig. 2).”
From Age-related variation in thyroid function – a narrative review highlighting important implications for research and clinical practice (2023) · cites this paper as [24]
The TSH threshold for levothyroxine initiation has been falling in recent years, with many older individuals increasingly started on Levothyroxine at borderline TSH levels.
“the TSH threshold for levothyroxine initiation has been falling in recent years with many older individuals increasingly started on Levothyroxine at borderline TSH levels [24].”
From Age-related variation in thyroid function – a narrative review highlighting important implications for research and clinical practice (2023) · cites this paper as [24]
Given the frequency of thyroid function testing, these interferences may impact numerous individuals.
“The prevalence of some of these conditions has been reported to approach 1% and given the frequency of thyroid function testing [117] this may impact numerus individuals.”
From Age-related variation in thyroid function – a narrative review highlighting important implications for research and clinical practice (2023) · cites this paper as [117]
The prevalence of some immunoassay interferences has been reported to approach 1%.
“The prevalence of some of these conditions has been reported to approach 1% and given the frequency of thyroid function testing [117] this may impact numerus individuals.”
From Age-related variation in thyroid function – a narrative review highlighting important implications for research and clinical practice (2023) · cites this paper as [117]
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“As reported by Taylor and colleagues [28], although a modest increase in the content of T4 (and T4-derived T3) found in the thyrotrophs will usually cause a substantial reduction in serum TSH in the setting of hypothyroidism, the same modest level of increase in peripheral tissues (liver, muscles, etc.”
BackgroundWhole-genome sequence-based analysis of thyroid function
Taylor, P. N., Porcu, E., Chew, S., Campbell, P. J., Traglia, M., Brown, S. J., Mullin, B. H., Shihab, H. A., Min, J., Walter, K., et al. (2015) · Nature Communications · doi:10.1038/ncomms6681 · Cited by 104 · see citing works
Self-citationLevothyroxine overuse: time for an about face?
Rodriguez-Gutierrez, R., Maraka, S., Ospina, N. S., Montori, V. M., & Brito, J. P. (2017) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(16)30276-5 · Cited by 100 · see citing works
Reference intervals in the diagnosis of thyroid dysfunction: treating patients not numbers
Jonklaas, J., & Razvi, S. (2019) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(18)30371-1 · Cited by 100 · see citing works
Mammen, J. S., McGready, J., Oxman, R., Chia, C. W., Ladenson, P. W., & Simonsick, E. M. (2015) · Thyroid · doi:10.1089/thy.2015.0180 · Cited by 94 · see citing works
Optimal thyroid hormone replacement
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Taylor, P. N., Lansdown, A., Witczak, J., Khan, R., Rees, A., Dayan, C. M., & Okosieme, O. (2023) · Thyroid Research · doi:10.1186/s13044-023-00149-5 · Cited by 72 · see citing works
Self-citationA 2013 Survey of Clinical Practice Patterns in the Management of Primary Hypothyroidism
Burch, H. B., Burman, K. D., Cooper, D. S., & Hennessey, J. V. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-1046 · Cited by 73 · see citing works
Thyroxine replacement: a clinical endocrinologist’s viewpoint
Eligar, V, Taylor, P., Okosieme, O., Leese, G., & Dayan, C. (2016) · Annals of Clinical Biochemistry: International Journal of Laboratory Medicine · doi:10.1177/0004563216642255 · Cited by 72 · see citing works
Self-citationAssociation of thyroid hormone treatment intensity with cardiovascular mortality among US veterans.
Evron, J. M., Hummel, S. L., Reyes-Gastelum, D., Haymart, M. R., Banerjee, M., & Papaleontiou, M. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.11863 · Cited by 75 · see citing works
Dayan, C., & Panicker, V. (2018) · Thyroid Research · doi:10.1186/s13044-018-0045-x · Cited by 62 · see citing works
Self-citationMedici, B. B., Nygaard, B., la Cour, J. L., Grand, M. K., Siersma, V., Nicolaisdottir, D. R., Lind, B., Olivarius, N. D. F., & Andersen, C. L. (2019) · Thyroid® · doi:10.1089/thy.2018.0539 · Cited by 63 · see citing works
Xu, Y., Derakhshan, A., Hysaj, O., Wildisen, L., Ittermann, T., Pingitore, A., Abolhassani, N., Medici, M., Kiemeney, L. A. L. M., Riksen, N. P., et al. (2023) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(23)00227-9 · Cited by 61 · see citing works
Levothyroxine: conventional and novel drug delivery formulations.
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Levothyroxine therapy in elderly patients with hypothyroidism
Effraimidis, G., Watt, T., & Feldt-Rasmussen, U. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.641560 · Cited by 60 · see citing works
Thyroid function across the lifespan: do age-related changes matter?
Walsh, J. P. (2022) · Endocrinology and Metabolism · doi:10.3803/enm.2022.1463 · Cited by 59 · see citing works
Michaelsson, L. F., Medici, B. B., la Cour, J. L., Selmer, C., Røder, M., Perrild, H., Knudsen, N., Faber, J., & Nygaard, B. (2015) · European Thyroid Journal · doi:10.1159/000437262 · Cited by 57 · see citing works
Burgos, N., Toloza, F. J. K., Singh Ospina, N. M., Brito, J. P., Salloum, R. G., Hassett, L. C., & Maraka, S. (2021) · Thyroid® · doi:10.1089/thy.2020.0679 · Cited by 53 · see citing works
Peng, C. C.-H., Huang, H.-K., Wu, B. B.-C., Chang, R. H.-E., Tu, Y.-K., & Munir, K. M. (2021) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaa777 · Cited by 52 · see citing works
Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients; the 2019 Italian Survey
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Trends, Determinants, and Associations of Treated Hypothyroidism in the United Kingdom, 2005–2014
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Self-citationAbdel-Moneim, A., Gaber, A. M., Gouda, S., Osama, A., Othman, S. I., & Allam, G. (2020) · Hormones · doi:10.1007/s42000-020-00208-8 · Cited by 45 · see citing works
Vita, R., Di Bari, F., & Benvenga, S. (2017) · Expert Opinion on Drug Delivery · doi:10.1080/17425247.2017.1290604 · Cited by 43 · see citing works
Ross, D. S. (2022) · Journal of Internal Medicine · doi:10.1111/joim.13410 · Cited by 42 · see citing works
Trifirò, G., Parrino, F., Sultana, J., Giorgianni, F., Ferrajolo, C., Bianchini, E., Medea, G., Benvenga, S., Cricelli, I., Cricelli, C., et al. (2015) · Clinical Drug Investigation · doi:10.1007/s40261-015-0271-0 · Cited by 40 · see citing works
Endogenous and exogenous thyrotoxicosis and risk of incident cognitive disorders in older adults.
Adams, R., Oh, E. S., Yasar, S., Lyketsos, C. G., & Mammen, J. S. (2023) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2023.5619 · Cited by 38 · see citing works
Roy Chengappa, K., Gannon, J., & Forrest, P. (2014) · Journal of Ayurveda and Integrative Medicine · doi:10.4103/0975-9476.146566 · Cited by 37 · see citing works
Ahluwalia, R., Baldeweg, S. E., Boelaert, K., Chatterjee, K., Dayan, C., Okosieme, O., Priestley, J., Taylor, P., Vaidya, B., Zammitt, N., et al. (2023) · Clinical Endocrinology · doi:10.1111/cen.14935 · Cited by 34 · see citing works
“14,19 However, in reality, many patients with subclinical hypothyroidism (TSH: 5 – 10 mU/L) are now treated with levothyroxine, 20,21 fuelling a rise in its use, such that it is now the third most frequently prescribed medication in the United Kingdom.”
BackgroundInfluentialSelf-citationMammen, J. S., McGready, J., Ladenson, P. W., & Simonsick, E. M. (2017) · Thyroid® · doi:10.1089/thy.2017.0211 · Cited by 34 · see citing works
Bednarczuk, T., Attanasio, R., Hegedüs, L., Nagy, E. V., Negro, R., Papini, E., Perros, P., & Ruchała, M. (2021) · Endokrynologia Polska · doi:10.5603/ep.a2021.0048 · Cited by 33 · see citing works
Rationalizing Thyroid Function Testing: Which TSH Cutoffs Are Optimal for Testing Free T4?
Henze, M., Brown, S. J., Hadlow, N. C., & Walsh, J. P. (2017) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2017-01322 · Cited by 31 · see citing works
Dew, R., King, K., Okosieme, O. E., Pearce, S. H., Donovan, G., Taylor, P. N., Hickey, J., Dayan, C. M., Leese, G., Razvi, S., et al. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-019970 · Cited by 31 · see citing works
Self-citationLevothyroxine/Liothyronine Combination Therapy and Quality of Life: Is It All about Weight Loss?
Michaelsson, L. F., la Cour, J. L., Medici, B. B., Watt, T., Faber, J., & Nygaard, B. (2018) · European Thyroid Journal · doi:10.1159/000490383 · Cited by 30 · see citing works
Risks and safety of combination therapy for hypothyroidism
Jonklaas, J. (2016) · Expert Review of Clinical Pharmacology · doi:10.1080/17512433.2016.1182019 · Cited by 27 · see citing works
Perros, P., Nagy, E. V., Papini, E., Van Der Feltz-Cornelis, C. M., Weetman, A. P., Hay, H. A., Abad-Madroñero, J., Tallett, A. J., Bilas, M., Lakwijk, P., et al. (2023) · Thyroid · doi:10.1089/thy.2022.0641 · Cited by 27 · see citing works
Thyroid Hormone Use in the United States, 1997–2016
Johansen, M. E., Marcinek, J. P., & Doo Young Yun, J. (2020) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2020.02.190159 · Cited by 23 · see citing works
Refractory hypothyroidism due to improper storage of levothyroxine tablets
Benvenga, S., Papi, G., & Antonelli, A. (2017) · Frontiers in Endocrinology · doi:10.3389/fendo.2017.00155 · Cited by 22 · see citing works
T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity
Wiersinga, W. M. (2021) · Endocrinology and Metabolism · doi:10.3803/enm.2021.501 · Cited by 21 · see citing works
“crease in the prevalence of treated subclinical hypothyroidism [27,28].”
BackgroundLevothyroxine prescriptions trends may indicate a downtrend in prescribing
Jonklaas, J., & DeSale, S. (2020) · Therapeutic Advances in Endocrinology and Metabolism · doi:10.1177/2042018820920551 · Cited by 19 · see citing works
Liothyronine cost and prescriptions in England
Taylor, P. N., Razvi, S., Muller, I., Wass, J., Dayan, C. M., Chatterjee, K., & Boelaert, K. (2019) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(18)30334-6 · Cited by 19 · see citing works
Self-citationPrevalence and factors associated with chronic use of levothyroxine: A cohort study
Janett-Pellegri, C., Wildisen, L., Feller, M., Del Giovane, C., Moutzouri, E., Grolimund, O., Walter, P., Waeber, G., Marques-Vidal, P., Vollenweider, P., et al. (2021) · PLOS ONE · doi:10.1371/journal.pone.0261160 · Cited by 17 · see citing works
Trends in costs and prescribing for liothyronine and levothyroxine in England and wales 2011–2020
Stedman, M., Taylor, P., Premawardhana, L., Okosieme, O., Dayan, C., & Heald, A. H. (2021) · Clinical Endocrinology · doi:10.1111/cen.14414 · Cited by 16 · see citing works
Self-citationManaging symptoms in hypothyroid patients on adequate levothyroxine: a narrative review
Razvi, S., Mrabeti, S., & Luster, M. (2020) · Endocrine Connections · doi:10.1530/ec-20-0205 · Cited by 15 · see citing works
“Current recommendations support the prescription of levothyroxine to some patients with subclinical hypothyroidism, particularly where TSH is >10 mU/L and FT4 is within the normal range [2], and the use of levothyroxine for the management of subclinical hypothyroidism appears to have increased [6,7].”
BackgroundAdverse effects of long-term Levothyroxine therapy in Subclinical Hypothyroidism
Ochani, S., Siddiqui, A., & Adnan, A. (2022) · Annals of Medicine & Surgery · doi:10.1016/j.amsu.2022.103503 · Cited by 15 · see citing works
Javaid, U., Kennedy, D., Addison, C., Tsatlidis, V., & Razvi, S. (2022) · European Journal of Endocrinology · doi:10.1530/eje-21-1172 · Cited by 14 · see citing works
L-T4 therapy in the presence of pharmacological interferents
Benvenga, S. (2020) · Frontiers in Endocrinology · doi:10.3389/fendo.2020.607446 · Cited by 13 · see citing works
Attanasio, R., Žarković, M., Papini, E., Nagy, E. V., Negro, R., Perros, P., Akarsu, E., Alevizaki, M., Ayvaz, G., Bednarczuk, T., et al. (2024) · Thyroid® · doi:10.1089/thy.2023.0580 · Cited by 11 · see citing works
Concurrent Use of Thyroid Hormone Therapy and Interfering Medications in Older US Veterans
Livecchi, R., Coe, A. B., Reyes-Gastelum, D., Banerjee, M., Haymart, M. R., & Papaleontiou, M. (2022) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgac216 · Cited by 10 · see citing works
Liothyronine and levothyroxine prescribing in England: A comprehensive survey and evaluation
Stedman, M., Taylor, P., Premawardhana, L., Okosieme, O., Dayan, C., & Heald, A. H. (2021) · International Journal of Clinical Practice · doi:10.1111/ijcp.14228 · Cited by 8 · see citing works
Self-citationDogra, P., Paudel, R., Panthi, S., Cassity, E., & Tannock, L. R. (2020) · International Journal of General Medicine · doi:10.2147/ijgm.s256868 · Cited by 6 · see citing works
Premawardhana, L. D., Taylor, P. N., Okosieme, O. E., Adlan, M. A., Obuobie, E. K., & Dayan, C. M. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1282608 · Cited by 6 · see citing works
Self-citation
- Authors
- Taylor, P. N., Iqbal, A., Minassian, C., Sayers, A., Draman, M. S., Greenwood, R., Hamilton, W., Okosieme, O., Panicker, V., Thomas, S. L., & Dayan, C.
- Affiliations
- University of Bristol (GB)
- London School of Hygiene & Tropical Medicine (GB)
- Cardiff University (GB)
- National Health Service (GB)
- University of Exeter (GB)
- Sir Charles Gairdner Hospital (AU)
- Corresponding author
- Taylor, Peter N.
- ORCID
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2014-01-01
- Volume
- 174
- Issue
- 1
- Pages
- 32
- ISSN
- 2168-6106 (ISSN-L)
- OpenAlex
- W2023846971
- Cited by
- 300
- References
- 28
- Citations by year
- 2026: 10 · 2025: 21 · 2024: 25 · 2023: 30 · 2022: 41 · 2021: 26 · 2020: 21 · 2019: 30 · 2018: 17 · 2017: 25 · 2016: 22 · 2015: 19 · 2014: 12 · 2013: 1
- FWCI
- 14.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Open Research Exeter (University of Exeter) (submittedVersion)
- Explore Bristol Research (submittedVersion)
- Funders
- Medical Research Council
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- subclinical hypothyroidism, overtreatment, thyroid function tests, older adults, cardiovascular risk factors, prescribing trends, Clinical Practice Research Datalink, United Kingdom, United States
- MeSH terms
- Aged, Drug Therapy, Female, United Kingdom, Humans, Hypothyroidism, Male, Middle Aged, Retrospective Studies, Thyrotropin, Thyroxine, Cohort Studies, Odds Ratio, Treatment Outcome, Risk Assessment
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