Levothyroxine and Quality of Life

[CoastWatcher]

Adults with hypothyroidism prescribed levothyroxine were more likely to experience lower health-related quality of life and increased comorbidities when compared with similar adults not prescribed thyroid hormone therapy.

• “Hypothyroidism is a common endocrine disorder, and substitution therapy with levothyroxine is the standard of care,” Hanneke Wouters of University Medical Center Groningen, Netherlands, said during an oral abstract presentation at the Endocrine Society Annual Meeting. “Unfortunately, about 10% of the individuals using this drug continue to experience symptoms and a disturbed wellbeing and a disturbed quality of life, despite the fact that their [thyroid-stimulating hormone] level is within the normal range, so they are euthyroid.”

• Wouters and colleagues analyzed data from 34,400 adults with thyroid function measurements participating in the population-based Dutch Lifelines cohort.

• Within the cohort, 995 adults (2.8% of total cohort) were prescribed levothyroxine. Compared with the population not prescribed levothyroxine, these patients were more likely to be women (89.4% vs. 57.9%), older (mean age, 51 years vs. 45 years), have higher BMI (mean, 27.2 kg/m² vs. 26.1 kg/m²) and use more medications (range, 0-4 vs. 0-2). Patients prescribed levothyroxine were also more likely to have a comorbidity vs. those not prescribed the drug (80.6% vs. 66%).
• Among those prescribed levothyroxine, 60% had a normal thyroid-stimulating hormone level (0.4-4 mU/L), 13.4% had TSH defined as suppressed (< 0.4 mU/L) and 26.6% had elevated TSH (at least 4 mU/L)
• Researchers found that patients prescribed levothyroxine had lower scores in all health-related quality-of-life domains, apart from emotional functioning, when compared with patients not on levothyroxine therapy (P < .001 for all). There were no between-group differences in health-related quality of life among patients prescribed levothyroxine therapy when stratified by TSH level or by levels of FT[SUB]3[/SUB] and FT[SUB]4.[/SUB]

[SUB]
"Levothyroxine therapy associated with lower quality of life in hypothyroidism,[/SUB] Helio, 22 March 2018, https://www.healio.com/endocrinolog...-with-lower-quality-of-life-in-hypothyroidism

 

[Vettester Chris]

I've personally never taken Levo T4 synthetic, more so just due to the excess negative results that I've read over and over throughout the years. NDT and Cytomel (T3) have always worked for me personally.

STTM has a page on this, they are not fans of Levothyroxine either https://stopthethyroidmadness.com/t4-only-meds-dont-work/

 

[LTChris]

Started with NDT now on Cytomel, still finding right dose. NDT worked well for a while but suddenly stopped working as well. I didn't know people were actually prescribed T4 alone. Interesting post, thanks

 

[Sean Mosher]

Chris, what dose T3 and NDT?
That seems to be a great combo for a lot of guys.....

 

[LTChris]

Ndt was 1.5 grains daily. For some reason numbers plummeted and rt3 shot up. Switched to t3 and am currently on 50mcg daily. Still calibrating dose

 

[DragonBits]

Adults with hypothyroidism prescribed levothyroxine were more likely to experience lower health-related quality of life and increased comorbidities when compared with similar adults not prescribed thyroid hormone therapy.

• “Hypothyroidism is a common endocrine disorder, and substitution therapy with levothyroxine is the standard of care,” Hanneke Wouters of University Medical Center Groningen, Netherlands, said during an oral abstract presentation at the Endocrine Society Annual Meeting. “Unfortunately, about 10% of the individuals using this drug continue to experience symptoms and a disturbed wellbeing and a disturbed quality of life, despite the fact that their [thyroid-stimulating hormone] level is within the normal range, so they are euthyroid.”

• Wouters and colleagues analyzed data from 34,400 adults with thyroid function measurements participating in the population-based Dutch Lifelines cohort.

• Within the cohort, 995 adults (2.8% of total cohort) were prescribed levothyroxine. Compared with the population not prescribed levothyroxine, these patients were more likely to be women (89.4% vs. 57.9%), older (mean age, 51 years vs. 45 years), have higher BMI (mean, 27.2 kg/m² vs. 26.1 kg/m²) and use more medications (range, 0-4 vs. 0-2). Patients prescribed levothyroxine were also more likely to have a comorbidity vs. those not prescribed the drug (80.6% vs. 66%).
• Among those prescribed levothyroxine, 60% had a normal thyroid-stimulating hormone level (0.4-4 mU/L), 13.4% had TSH defined as suppressed (< 0.4 mU/L) and 26.6% had elevated TSH (at least 4 mU/L)
• Researchers found that patients prescribed levothyroxine had lower scores in all health-related quality-of-life domains, apart from emotional functioning, when compared with patients not on levothyroxine therapy (P < .001 for all). There were no between-group differences in health-related quality of life among patients prescribed levothyroxine therapy when stratified by TSH level or by levels of FT[SUB]3[/SUB] and FT[SUB]4.[/SUB]

[SUB]
"Levothyroxine therapy associated with lower quality of life in hypothyroidism,[/SUB] Helio, 22 March 2018, https://www.healio.com/endocrinolog...-with-lower-quality-of-life-in-hypothyroidism

Seems like an odd sort of study.

Patients treated with Levothyroxine improved their quality of life, but still had poorer quality of life than those people with normal functioning thyroids.

No other thyroid treatment was studied so no one knows if any other treatment will improve quality of life to the normal population?

Compared with adults not prescribed levothyroxine, those prescribed levothyroxine were more likely to have hypertension (34.9%), anemia (26%) and hypercholesterolemia (23.7%) after adjustment for age and BMI. Diabetes and multiple sclerosis were also more likely in patients prescribed levothyroxine therapy; however, there were no between-group differences for other autoimmune diseases, Wouters said.

I am also not sure about this, does it mean that those on levothyroxine had additional problems affecting quality of life and those were included?

 

[ratbag]

I think this is a good example that some of us do not convert T4 into T3 well. Standard medical practise is to use only T4. So if they do not convert well they remain hypothyroid.