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Effects of Treatment With Metformin on TSH Levels: A Meta-analysis of Literature Studies
Abstract
CONTEXT: Some data suggest that metformin affects the thyroid profile in patients with type 2 diabetes, but contrasting results are reported in different settings. OBJECTIVE: The aim of this meta-analysis was to assess the effect of metformin treatment on TSH in subjects with or without thyroid dysfunction. DATA SOURCES: We performed a systematic search of articles evaluating changes in TSH levels in patients receiving metformin. STUDY SELECTION: Studies evaluating TSH levels before and after metformin treatment were included. DATA EXTRACTION: Clinical data, demographic variables, and TSH levels before and after treatment with metformin were extracted. Data were analyzed according to the underlying thyroid disease. DATA SYNTHESIS: A total of 7 datasets (206 patients) were included in the final analysis. After metformin treatment, a slight but significant reduction in TSH levels was found in 4 datasets on 119 patients with overt hypothyroidism receiving l-T4 replacement (mean difference, 1.08; 95% confidence interval [CI], 0.50, 1.65; P=.0003). Similarly, in 2 datasets reporting on a total of 33 patients with subclinical hypothyroidism not receiving treatment with l-T4, a significant reduction in TSH levels was reported (mean difference, 1.59; 95% CI, 1.32, 1.87; P<.00001) after treatment with metformin. In 1 dataset, including 54 euthyroid patients not receiving l-T4, no changes in TSH levels were reported after treatment with metformin (mean difference, 0.18; 95% CI, -0.20, 0.56; P=.35). CONCLUSIONS: Metformin induces a reduction in TSH levels both in overt and in subclinical hypothyroidism. In contrast, no change in TSH levels is found in euthyroid patients.
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“Metformin lowers serum TSH in L-T4-treated OH and L-T4-untreated SCH patients, but not in euthyroid patients (33).”
From L-T4 therapy in the presence of pharmacological interferents (2020) · cites this paper as [33]
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The Research Progress on the Effect of Metformin on Serum Thyrotropin Level
宋, 静. (2023) · Advances in Clinical Medicine · doi:10.12677/acm.2023.131017
The Effect of Metformin on Thyroid Nodules
Talaei, A., Rafiei, F., Motamedi, G., & Chehrei, A. (2025) · مجله دانشگاه علوم پزشکی اراک · doi:10.61882/jams.28.2.141
Pharmacological Interactions of Levothyroxine in Multiple-Treated Patients
Marco, F. D., & Cusini, C. (2025) · Springer eBooks · doi:10.1007/978-3-032-01700-0_14
Krysiak, R. G., Kowalcze, K. E., Ott, J., Zaami, S., Gullo, G., & Okopień, B. (2026) · Nutrients · doi:10.3390/nu18050838
Krysiak, R. G., Kowalcze, K. E., Cangelosi, G., Deledda, A., & Okopień, B. (2026) · Nutrients · doi:10.3390/nu18071062
Metadata
- Authors
- Lupoli, R., Di Minno, A., Tortora, A., Ambrosino, P., Arianna Lupoli, G., & Di Minno, M. N. D.
- Affiliations
- Federico II University Hospital (IT)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2014-01
- Volume
- 99
- Issue
- 1
- Pages
- E143-E148
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2103695808
- Cited by
- 102
- References
- 25
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 5 · 2023: 8 · 2022: 10 · 2021: 8 · 2020: 11 · 2019: 10 · 2018: 9 · 2017: 9 · 2016: 4 · 2015: 6 · 2014: 8
- FWCI
- 0.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Pfizer
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- metformin, thyroid-stimulating hormone, type 2 diabetes, overt hypothyroidism, subclinical hypothyroidism, thyroid dysfunction, levothyroxine, euthyroid patients, drug effects on thyroid function
- MeSH terms
- Humans, Hypoglycemic Agents, Hypothyroidism, Metformin, Thyrotropin, Thyroxine, Hormone Replacement Therapy
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