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June 21, 2021

Overuse of Levothyroxine in Patients With Subclinical Hypothyroidism: Time to “Leve”-Out-Thyroxine

Author Affiliations
  • 1Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  • 2Teachable Moments Editorial Fellow, JAMA Internal Medicine
  • 3Department of Medicine, University of California, San Francisco
  • 4Deputy Editor, JAMA Internal Medicine
JAMA Intern Med. Published online June 21, 2021. doi:10.1001/jamainternmed.2021.2690

Recent clinical trials1,2 and a meta-analysis3 demonstrate no symptomatic benefit from treatment with levothyroxine among nonpregnant adults with subclinical hypothyroidism (defined as an elevated thyrotropin level with normal serum thyroid hormone levels). Contemporary evidence-based clinical practice guidelines strongly advise against levothyroxine supplementation for subclinical hypothyroidism.3,4 Older guidelines from professional societies generally do not recommend treatment for subclinical hypothyroidism with a thyrotropin level less than 10 mIU/L, except in special circumstances.5,6

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