Cited by 330Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryHormonal and reproductive studies

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Thyroid hormone replacement for subclinical hypothyroidism

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Villar, Heloisa Cerqueira Cesar Esteves, Saconato, Humberto, Valente, Orsine, Atallah, Álvaro N·2007·Cochrane Database of Systematic Reviews

DOI 10.1002/14651858.cd003419.pub2PMC PMC6610974

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Abstract

BACKGROUND: Subclinical hypothyroidism is defined as an elevated serum thyroid-stimulating hormone (TSH) level with normal free thyroid hormones values. The prevalence of subclinical hypothyroidism is 4% to 8% in the general population, and up to 15% to 18% in women who are over 60 years of age. There is considerable controversy regarding the morbidity, the clinical significance of subclinical hypothyroidism and if these patients should be treated. OBJECTIVES: To assess the effects of thyroid hormone replacement for subclinical hypothyroidism. SEARCH STRATEGY: We searched The Cochrane Library, MEDLINE, EMBASE and LILACS. Ongoing trials databases, reference lists and abstracts of congresses were scrutinized as well. SELECTION CRITERIA: All studies had to be randomised controlled trials comparing thyroid hormone replacement with placebo or no treatment in adults with subclinical hypothyroidism. Minimum duration of follow-up was one month. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. We contacted study authors for missing or additional information. MAIN RESULTS: Twelve trials of six to 14 months duration involving 350 people were included. Eleven trials investigated levothyroxine replacement with placebo, one study compared levothyroxine replacement with no treatment. We did not identify any trial that assessed (cardiovascular) mortality or morbidity. Seven studies evaluated symptoms, mood and quality of life with no statistically significant improvement. One study showed a statistically significant improvement in cognitive function. Six studies assessed serum lipids, there was a trend for reduction in some parameters following levothyroxine replacement. Some echocardiographic parameters improved after levothyroxine replacement therapy, like myocardial relaxation, as indicated by a significant prolongation of the isovolumic relaxation time as well as diastolic dysfunction. Only four studies reported adverse events with no statistically significant differences between groups. AUTHORS' CONCLUSIONS: In current RCTs, levothyroxine replacement therapy for subclinical hypothyroidism did not result in improved survival or decreased cardiovascular morbidity. Data on health-related quality of life and symptoms did not demonstrate significant differences between intervention groups. Some evidence indicates that levothyroxine replacement improves some parameters of lipid profiles and left ventricular function.

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Authors: Villar, H. C. C. E., Saconato, H., Valente, O., & Atallah, Á. N.
Affiliations: Faculdade de Medicina de Marília (BR)
Universidade Federal do Rio Grande do Norte (BR)
Universidade Federal de São Paulo (BR)
Cochrane (BR)
ORCID: Saconato, Humberto
Atallah, Álvaro N
Venue: Cochrane Database of Systematic Reviews
Publisher: Wiley
Published: 2007-07-18
Volume: 2009
Issue: 1
Pages: CD003419-CD003419
ISSN: 1361-6137 (ISSN-L)
1465-1858
DOI: 10.1002/14651858.cd003419.pub2
PMC: PMC6610974
OpenAlex: W1755700101
Cited by: 329
References: 82
Citations by year: 2026: 4 · 2025: 5 · 2024: 4 · 2023: 8 · 2022: 11 · 2021: 18 · 2020: 74 · 2019: 13 · 2018: 23 · 2017: 24 · 2016: 12 · 2015: 22 · 2014: 19 · 2013: 23 · 2012: 16
FWCI: 1.63
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Cochrane Database of Systematic Reviews (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
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 › Hormonal and reproductive studies
Keywords: subclinical hypothyroidism, levothyroxine, thyroid hormone replacement, thyroid-stimulating hormone, cardiovascular morbidity, cardiovascular mortality, health-related quality of life, cognitive function, serum lipids, left ventricular function, diastolic dysfunction, adverse events
MeSH terms: Adult, Cardiovascular System, Cholesterol, Humans, Hypothyroidism, Thyroxine, Randomized Controlled Trials as Topic, Hormone Replacement Therapy

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Thyroid hormone replacement for subclinical hypothyroidism

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