Back to Search
Start Over
Impact of Thyroid Hormone Therapy on Atherosclerosis in the Elderly with Subclinical Hypothyroidism: A Randomized Trial
- Source :
- Journal of Clinical Endocrinology and Metabolism, 103(8), 2988-2997
- Publication Year :
- 2018
- Publisher :
- The Endocrine Society, 2018.
-
Abstract
- Context Subclinical hypothyroidism (SHypo) has been associated with atherosclerosis, but no conclusive clinical trials assessing the levothyroxine impact on carotid atherosclerosis exist. Objective To assess the impact of treatment of SHypo with levothyroxine on carotid atherosclerosis. Design and Setting Randomized, double-blind, placebo-controlled trial nested within the Thyroid Hormone Replacement for Subclinical Hypothyroidism trial. Participants Participants aged ≥65 years with SHypo [thyroid-stimulating hormone (TSH), 4.60 to 19.99 mIU/L; free thyroxine level within reference range]. Intervention Levothyroxine dose-titrated to achieve TSH normalization or placebo, including mock titrations. Main Outcome Measures Carotid intima media thickness (CIMT), maximum plaque thickness measured with ultrasound. Results One hundred eighty-five participants (mean age 74.1 years, 47% women, 96 randomized to levothyroxine) underwent carotid ultrasound. Overall mean TSH ± SD was 6.35 ± 1.95 mIU/L at baseline and decreased to 3.55 ± 2.14 mIU/L with levothyroxine compared with 5.29 ± 2.21 mIU/L with placebo (P < 0.001). After a median treatment of 18.4 months (interquartile range 12.2 to 30.0 months), mean CIMT was 0.85 ± 0.14 mm under levothyroxine and 0.82 ± 0.13 mm under placebo [between-group difference = 0.02 mm; 95% CI, −0.01 to 0.06; P = 0.30]. The proportion of carotid plaque was similar (n = 135; 70.8% under levothyroxine and 75.3% under placebo; P = 0.46). Maximum carotid plaque thickness was 2.38 ± 0.92 mm under levothyroxine and 2.37 ± 0.91 mm under placebo (between-group difference −0.03; 95% CI, −0.34 to 0.29; P = 0.86). There were no significant interactions between levothyroxine treatment and mean CIMT, according to sex, baseline TSH (categories 4.6 to 6.9, 7.0 to 9.9, and ≥10 mIU/L), or established cardiovascular disease (all P for interaction ≥ 0.14). Conclusion Normalization of TSH with levothyroxine was associated with no difference in CIMT and carotid atherosclerosis in older persons with SHypo.
- Subjects :
- Male
medicine.medical_specialty
Thyroid Hormones
endocrine system diseases
Hormone Replacement Therapy
Endocrinology, Diabetes and Metabolism
Clinical Biochemistry
Levothyroxine
Thyrotropin
Context (language use)
030204 cardiovascular system & hematology
Thyroid Function Tests
Placebo
Biochemistry
Thyroid function tests
Gastroenterology
law.invention
03 medical and health sciences
0302 clinical medicine
Endocrinology
Randomized controlled trial
Double-Blind Method
Hypothyroidism
Interquartile range
law
Internal medicine
Medicine
Humans
030212 general & internal medicine
610 Medicine & health
Aged
Aged, 80 and over
medicine.diagnostic_test
business.industry
Biochemistry (medical)
Thyroid
Atherosclerosis
Thyroxine
medicine.anatomical_structure
Intima-media thickness
Asymptomatic Diseases
Female
business
360 Social problems & social services
medicine.drug
Subjects
Details
- Language :
- English
- ISSN :
- 0021972X
- Database :
- OpenAIRE
- Journal :
- Journal of Clinical Endocrinology and Metabolism, 103(8), 2988-2997
- Accession number :
- edsair.doi.dedup.....2eddf18c667bfc5ac6d53bc50f0330ec
- Full Text :
- https://doi.org/10.7892/boris.117158