Thyrotropin Suppression by Metformin
Abstract
Context: Drug-drug interactions are common but often are discovered only long after initial drug release. Metformin has been available in the United States for 9 yr and elsewhere for many years, but as of yet there are no reports that the drug modifies thyroid hormone economy. Objective: The objective of the study was to describe the clinical and biochemical findings of four patients with chronic hypothyroidism, previously euthyroid on fixed doses of l-T4 for several years, in whom the metformin was initiated. Design: This was a retrospective review. Setting: The study was conducted at a tertiary care military hospital providing care to active-duty soldiers, sailors, and marines, retirees of the armed forces, and their eligible dependents. Participants: Four patients with chronic hypothyroidism who were placed on metformin participated in the study. Intervention, Main Outcome Measure: Serum TSH, free T4, and free T3 levels were measured during metformin treatment. Results: Initiation of treatment with metformin (three for diabetes mellitus and one for nonalcoholic steatohepatitis) caused suppression of TSH to subnormal levels without clinical symptoms of hyperthyroidism in any patients. There was no change in free T4 or free T3 in patient 1. Conclusions: No other potential causes of TSH suppression, including medication changes or interference in the TSH assay, could be identified. The mechanism of the fall in serum TSH in these four patients is unclear at this time. Should these findings be confirmed in larger prospective studies, metformin’s ability to suppress TSH without causing clinical or chemical hyperthyroidism might render this drug a useful adjunct to the treatment of patients with thyroid cancer.
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Metformin decreases serum levels of thyrotropin to subnormal levels in hypothyroid patients who use levothyroxine regularly.
“Metformin decreases serum levels of thyrotropin (TSH) to subnormal levels in hypothyroid patients that use levothyroxin (LT4) on a regular basis [112].”
From Metformin: An Old But Still the Best Treatment for Type 2 Diabetes (2013) · cites this paper as [112]
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- Authors
- Vigersky, R. A., Filmore-Nassar, A., & Glass, A. R.
- Affiliations
- Walter Reed National Military Medical Center (US)
- Corresponding author
- Vigersky, Robert A.
- ORCID
- Vigersky, Robert A.
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2006-01-01
- Volume
- 91
- Issue
- 1
- Pages
- 225-227
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W1979756450
- Cited by
- 174
- References
- 12
- Citations by year
- 2026: 1 · 2025: 8 · 2024: 6 · 2023: 6 · 2022: 13 · 2021: 8 · 2020: 6 · 2019: 9 · 2018: 8 · 2017: 16 · 2016: 7 · 2015: 12 · 2014: 14 · 2013: 15 · 2012: 10
- FWCI
- 4.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Defense
- U.S. Army
- 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 › Growth Hormone and Insulin-like Growth Factors
- Keywords
- metformin, TSH suppression, thyroid-stimulating hormone, drug-drug interactions, thyroid hormone levels, free thyroxine, free T3, nonalcoholic steatohepatitis, diabetes mellitus
- MeSH terms
- Aged, Diabetes Mellitus, Type 2, Diabetic Nephropathies, Drug Interactions, Female, Goiter, Graves Disease, Humans, Hypoglycemic Agents, Hypothyroidism, Liver Function Tests, Male, Metformin, Middle Aged, Retrospective Studies, Thyroid Function Tests, Thyroidectomy, Thyrotropin, Triiodothyronine, Hashimoto Disease
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