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Comment & Response
February 26, 2019

Thyroid Hormone Therapy for Subclinical Hypothyroidism—Reply

Author Affiliations
  • 1Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland
  • 2Institute of Primary Health Care, University of Bern, Bern, Switzerland
  • 3Department of Endocrinology/General Internal Medicine, Leiden University Center, Leiden, the Netherlands
JAMA. 2019;321(8):804-805. doi:10.1001/jama.2018.20006

In Reply Dr Razvi and colleagues argue that the negative results in our meta-analysis of thyroid hormone therapy in persons with subclinical hypothyroidism for QOL were driven by TRUST1 and that this trial was negative because it “recruited largely asymptomatic older individuals with subclinical hypothyroidism.” However, the TRUST participants were not “largely asymptomatic”: the mean ThyPRO hypothyroid symptom score at baseline was 17 and the mean tiredness score was 25 (range for both scores, 0-100, with higher scores indicating worse symptoms), and only 5% had no hypothyroid symptoms.1 If we exclude TRUST and reanalyze the meta-analysis for QOL, the mean age of the 158 participants from the remaining 3 RCTs decreases to 55 years, and this restricted analysis also indicates no benefit of levothyroxine treatment (standardized mean difference [positive values indicate benefit of levothyroxine], −0.18; 95% CI, −0.50 to 0.14). Therefore, our results for the meta-analysis for QOL were robust and not solely dependent on TRUST.

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