Does treatment with L-thyroxine influence health status in middle-aged and older adults with subclinical hypothyroidism?

被引:164
作者
Jaeschke, R [1 ]
Guyatt, G [1 ]
Gerstein, H [1 ]
Patterson, C [1 ]
Molloy, W [1 ]
Cook, D [1 ]
Harper, S [1 ]
Griffith, L [1 ]
Carbotte, R [1 ]
机构
[1] MCMASTER UNIV,DEPT MED,HAMILTON,ON,CANADA
关键词
subclinical hypothyroidism; quality of life; elderly;
D O I
10.1007/BF02598988
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
OBJECTIVE: To determine if health-related quality of life (HRQL) in patients of middle age and older with elevated thyroid-stimulating hormone (TSH) and normal total thyroid hormone levels-subclinical hypothyroidism-improves with L-thyroxine replacement therapy. DESIGN:Randomized, double-blind, placebo-controlled trial. SETTING: Outpatient clinic. PATIENTS: Thirty-seven patients with subclinical hypothyroidism, most with symptoms consistent with hypothyroidism, over 55 years of age. INTERVENTIONS: Placebo or L-thyroxine replacement therapy to achieve normal TSH level. MEASUREMENTS AND MAIN RESULTS: Disease-specific and general HRQL, cognitive function, bone mineral density, lipid levels. The mean daily dose of L-thyroxine replacement in the active group was 68 +/- 21 mu g. TSH decreased by 8.6 mIU/L (95% confidence interval [CI] 4.1 to 13.1) and T-4 increased by 27.9 nmol/L (95% CI 14.8 to 41.2). There was a statistically significant improvement in a composite psychometric memory score in treated versus control patients; all other outcomes showed similar findings in the two groups. Although confidence intervals for most measures did not exclude an important improvement in HRQL with thyroid replacement, no measure of symptoms or HRQL either showed clinically important trends in favor of treatment, or approached conventional levels of statistical significance. CONCLUSIONS: In middle-aged and older patients with elevated TSH and normal T-4, it may not be harmful to follow biochemical and clinical status even in the presence of nonspecific symptoms potentially associated with hypothyroidism.
引用
收藏
页码:744 / 749
页数:6
相关论文
共 35 条
  • [1] SCREENING FOR HYPOTHYROIDISM IN ELDERLY INPATIENTS
    BAHEMUKA, M
    HODKINSON, HM
    [J]. BMJ-BRITISH MEDICAL JOURNAL, 1975, 2 (5971): : 601 - 603
  • [2] BANSAL SK, 1986, BRIT J CLIN PRACT, V40, P17
  • [3] END-ORGAN RESPONSES TO THYROXINE THERAPY IN SUBCLINICAL HYPOTHYROIDISM
    BELL, GM
    TODD, WTA
    FORFAR, JC
    MARTYN, C
    WATHEN, CG
    GOW, S
    RIEMERSMA, R
    TOFT, AD
    [J]. CLINICAL ENDOCRINOLOGY, 1985, 22 (01) : 83 - 89
  • [4] BERGNER M, 1981, MED CARE, V19, P797
  • [5] THYROID-DISORDERS IN THE ELDERLY - DIFFICULTIES IN DIAGNOSIS AND TREATMENT
    CAMPBELL, AJ
    [J]. DRUGS, 1986, 31 (05) : 455 - 461
  • [6] COINDRE JM, 1986, ARCH INTERN MED, V146, P48, DOI 10.1001/archinte.146.1.48
  • [7] L-THYROXINE THERAPY IN SUBCLINICAL HYPOTHYROIDISM - A DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL
    COOPER, DS
    HALPERN, R
    WOOD, LC
    LEVIN, AA
    RIDGWAY, EC
    [J]. ANNALS OF INTERNAL MEDICINE, 1984, 101 (01) : 18 - 24
  • [8] SUBCLINICAL HYPOTHYROIDISM
    COOPER, DS
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1987, 258 (02): : 246 - 247
  • [9] COOPER DS, 1986, LANCET, P251
  • [10] CORTICOSTEROIDS AND NEUROPSYCHOLOGICAL FUNCTIONING IN PATIENTS WITH SYSTEMIC LUPUS-ERYTHEMATOSUS
    DENBURG, SD
    CARBOTTE, RM
    DENBURG, JA
    [J]. ARTHRITIS AND RHEUMATISM, 1994, 37 (09): : 1311 - 1320