Concurrent Use of Thyroid Hormone Therapy and Interfering Medications in Older US Veterans
Open accessAbstract
Context: Thyroid hormone management in older adults is complicated by comorbidities and polypharmacy. Objective: Determine the prevalence of concurrent use of thyroid hormone and medications that can interfere with thyroid hormone metabolism (amiodarone, prednisone, prednisolone, carbamazepine, phenytoin, phenobarbital, tamoxifen), and patient characteristics associated with this practice. Design: Retrospective cohort study between 2004 and 2017 (median follow-up, 56 months). Setting: Veterans Health Administration Corporate Data Warehouse. Participants: A total of 538 137 adults ≥ 65 years prescribed thyroid hormone therapy during the study period. Main Outcome Measure: Concurrent use of thyroid hormone and medications interfering with thyroid hormone metabolism. Results: Overall, 168 878 (31.4%) patients were on at least 1 interfering medication while on thyroid hormone during the study period. In multivariable analyses, Black/African-American race (odds ratio [OR], 1.25; 95% CI, 1.21-1.28, compared with White), Hispanic ethnicity (OR, 1.12; 95% CI, 1.09-1.15, compared with non-Hispanic), female (OR, 1.11; 95% CI, 1.08-1.15, compared with male), and presence of comorbidities (eg, Charlson/Deyo Comorbidity Score ≥ 2; OR, 2.50; 95% CI, 2.45-2.54, compared with 0) were more likely to be associated with concurrent use of thyroid hormone and interfering medications. Older age (eg, ≥ 85 years; OR, 0.48; 95% CI, 0.47-0.48, compared with age 65-74 years) was less likely to be associated with this practice. Conclusions and Relevance: Almost one-third of older adults on thyroid hormone were on medications known to interfere with thyroid hormone metabolism. Our findings highlight the complexity of thyroid hormone management in older adults, especially in women and minorities.
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A recent large cohort study found that approximately one third of older hypothyroid patients on levothyroxine treatment had taken at least one medication that interferes with thyroid hormones.
“A recent large cohort study found that approximately 1/3 of older hypothyroid patients on LT4 treatment had taken at least one medication that interferes with thyroid hormones [39].”
From Risks of suboptimal and excessive thyroid hormone replacement across ages (2023) · cites this paper as [39]
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References 33 · Cited by 10
Research works printed but not linked: 2
- IQVIA. Medicine Use and Spending in the U.S. A Review of 2018 and Outlook to 2023 Institute Report, May 09, 2019. 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 July 1, 2021.
- Livadas S, Bothou C, Androulakis I, Boniakos A, Angelopoulos N, Duntas L. Levothyroxine replacement therapy and overuse: a timely diagnostic approach. Thyroid 2019;29(8):1169.
- Authors
- Livecchi, R., Coe, A. B., Reyes-Gastelum, D., Banerjee, M., Haymart, M. R., & Papaleontiou, M.
- Affiliations
- University of Michigan (US)
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan , Ann Arbor, MI 48109 , USA
- Corresponding author
- Papaleontiou, Maria
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2022-04-09
- Volume
- 107
- Issue
- 7
- Pages
- e2738-e2742
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC9202690
- OpenAlex
- W4223629120
- Cited by
- 10
- References
- 33
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 1 · 2023: 4 · 2022: 1
- FWCI
- 1.30
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (K08 AG049684, K08 AG071856)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- thyroid hormone replacement, drug interactions, thyroid hormone metabolism, polypharmacy, older adults, veterans, amiodarone, glucocorticoids, antiepileptic drugs, tamoxifen, comorbidities, racial and ethnic disparities, sex differences
- MeSH terms
- Aged, Pharmaceutical Preparations, Female, Humans, Male, Retrospective Studies, Thyroid Hormones, United States, Veterans, Racial Groups
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