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Cited by 19Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryHealthcare cost, quality, practices

Levothyroxine prescriptions trends may indicate a downtrend in prescribing

Open access
Jonklaas, Jacqueline, DeSale, Sameer·2020·Therapeutic Advances in Endocrinology and Metabolism
DOI 10.1177/2042018820920551PMC PMC7238309
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Abstract

BACKGROUND: There has been a trend for increased prescribing of levothyroxine (LT4) in many countries, including the United States. Several different factors have been suggested to be the cause of this practice pattern. These factors include increased size of the United States population, more diagnosis of hypothyroidism, more treatment of minimally elevated thyroid-stimulating hormone (TSH) levels, more use of LT4 in older patients, and use of LT4 for treatment of euthyroid patients with non-thyroidal conditions. METHODS: The electronic databases of the MedStar Health system operating in the Washington, DC and Maryland areas were interrogated to determine the number of patients who were being prescribed levothyroxine during the time period 2008-2016, the number of prescriptions supplied to these individuals, the associated diagnosis, and whether the prescriptions were new or existing prescriptions. Regression analyses were also performed to determine the prescribing trends during this time period. RESULTS: Although the annual number of levothyroxine prescriptions increased during this time period, the percentage of patients in the database receiving levothyroxine for hypothyroidism initially increased and then decreased over time (2.5% to 3.2% to 2.5%). The percentage of prescriptions written for patients who did not appear to carry a diagnosis of hypothyroidism steadily declined (3.5% to 1.0%). Although the percentage of patients with existing prescriptions for hypothyroidism initially increased and then were maintained at steady levels (1.4% to 2.4% to 2.2%), a smaller percentage of patients with existing prescriptions were documented over time when there was no diagnosis of hypothyroidism (1.45% to 0.89%). The percentage of patients with new prescriptions declined over time for all groups. The number of annual 90-day period prescriptions increased over the time for patients with a diagnosis of hypothyroidism, but down-trended starting over the latter part of the time period for those patients without a diagnosis of hypothyroidism. CONCLUSION: Taken together, these data suggest that there may be a stabilization, and even a down-trend in levothyroxine prescribing with the MedStar system. The decrease in levothyroxine prescribing appears to be accounted for by less use of levothyroxine without an established diagnosis of hypothyroidism, and less initiation of new prescriptions.

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  • LT4 as monotherapy is the mainstay of treatment of hypothyroidism and its use has increased over time, remaining one of the most prescribed medications worldwide.

    “Sodium levothyroxine (LT4) as a monotherapy represents the mainstay of treatment of hypothyroidism, and its use has been increasing over time reaching a steady state in recent years remaining, however, one of the most prescribed medication worldwide (1).”

    From ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism (2025) · cites this paper as [1]

    The Introduction reports increased LT4 prescribing over time and ranks it among the most prescribed drugs in the United States; it also describes increases in several other countries. It does not establish a worldwide ranking or explicitly identify LT4 monotherapy as the mainstay of treatment. The claimed recent steady state is also too broad: the Introduction reports fewer US prescriptions in 2017–2018, while the Discussion describes stabilization followed by a decline in the studied healthcare system. (LLM, conf=0.85)

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Research works printed but not linked: 3

  1. [3]Medicine Use and Spending in the U.S. A Review of 2017 and Outlook to 2022 Institute Report Apr 19, 2018. The IQVIA Institute https://www.iqvia.com/insights/the-iqvia-institute/reports/medicine-use-and-spending-in-the-us-review-of-2017-outlook-to-2022 (accessed 15 April 2020).
  2. [4]Medicine Use and Spending in the U.S. A Review of 2018 and Outlook to 2023 Institute Report May 09, 2019. The IQVIA Institute https://www.iqvia.com/insights/the-iqvia-institute/reports/medicine-use-and-spending-in-the-us-a-review-of-2018-and-outlook-to-2023 (accessed 15 April 2020).
  3. [6]Prevalence and Incidence of Hypothyroidism from Endocrine Facts and Figures, First Edition, Endocrine Society. Table 18 (Sources: National Ambulatory Medical Care Survey 2010; National Hospital Discharge Survey 2010). https://www.endocrine.org/topics/thyroid-disorders-and-cancer/facts-and-figures (accessed 15 April 2020).

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Authors
Jonklaas, J., & DeSale, S.
Affiliations
  • Georgetown University (US)
  • MedStar Health Research Institute (US)
Corresponding author
Jonklaas, Jacqueline
ORCID
Venue
Therapeutic Advances in Endocrinology and Metabolism
Publisher
SAGE Publications
Published
2020-01
Volume
11
Pages
2042018820920551-2042018820920551
ISSN
  • 2042-0188 (ISSN-L)
  • 2042-0196
DOI
10.1177/2042018820920551
PMC
PMC7238309
OpenAlex
W3026264268
Cited by
19
References
17
Citations by year
2026: 2 · 2025: 5 · 2024: 2 · 2023: 3 · 2022: 2 · 2021: 5
FWCI
1.89
Type
journal article
Language
en
Open access
Licence
Locations
  • Therapeutic Advances in Endocrinology and Metabolism (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
National Institutes of Health (UL1TR001409)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
  • Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
Keywords
levothyroxine, prescribing trends, hypothyroidism, thyroid-stimulating hormone, overtreatment, inappropriate prescribing, medication utilization

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