불현성 갑상선기능저하증 노인 환자에서 Levothyroxine 치료 효과 분석
Analysis of the Effect of Levothyroxine Treatment in Elderly Patients with Subclinical Hypothyroidism
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Background : Subclinical hypothyroidism (SCH) is defined as a serum thyroid-stimulating hormone (TSH) level above the upper limit of normal despite normal levels of serum thyroid hormone. Most SCH patients are asymptomatic, and whether to treat with levothyroxine (LT4) or not remains controversial. It is necessary to establish more specific treatment criteria. Thus, we studied if other biochemical indicators, the serum triiodothyronine (T3)/free thyroxine (fT4) ratio, could facilitate in determining whether to use LT4 for the treatment of SCH in the elderly. Methods : Among patients older than 65 who visited a tertiary hospital January 2009-December 2018, patients with serum T3 and fT4 test results with TSH level ≥ 4.5 mIU/L and < 10.0 mIU/L were included in this study. These patients were divided into LT4 and non-LT4 groups and observed until normal serum TSH level was reached for up to two years. We analyzed the number of patients who reached normal serum TSH level and the time to return normal TSH level according to LT4. We also analyzed the ratio influence. Results : Of the 108 subjects (total), 39 were in the LT4 group. The rate of reaching normal serum TSH level was significantly higher in the LT4 group than non-LT4 group (100% vs 85.5%, p=0.01). The period to reach normal serum TSH level was 2.9 months (2.4-4.0) in the LT4 group and 2.8 months (1.9-3.6) in the non-LT4 group (p=0.49). The period decreased during LT4 treatment, as the ratio decreased, but there was no significance (HR 0.15, p=0.10). Conclusion : Elderly SCH patients older than 65 with a serum TSH level ≥ 4.5 mIU/L and < 10.0 mIU/L may consider monitoring their progress every 6 months without using drugs until 18 months when deciding on LT4.
Abstract
Background : Subclinical hypothyroidism (SCH) is defined as a serum thyroid-stimulating hormone (TSH) level above the upper limit of normal despite normal levels of serum thyroid hormone. Most SCH patients are asymptomatic, and whether to treat with levothyroxine (LT4) or not remains controversial. It is necessary to establish more specific treatment criteria. Thus, we studied if other biochemical indicators, the serum triiodothyronine (T3)/free thyroxine (fT4) ratio, could facilitate in determining whether to use LT4 for the treatment of SCH in the elderly. Methods : Among patients older than 65 who visited a tertiary hospital January 2009-December 2018, patients with serum T3 and fT4 test results with TSH level ≥ 4.5 mIU/L and < 10.0 mIU/L were included in this study. These patients were divided into LT4 and non-LT4 groups and observed until normal serum TSH level was reached for up to two years. We analyzed the number of patients who reached normal serum TSH level and the time to return normal TSH level according to LT4. We also analyzed the ratio influence. Results : Of the 108 subjects (total), 39 were in the LT4 group. The rate of reaching normal serum TSH level was significantly higher in the LT4 group than non-LT4 group (100% vs 85.5%, p=0.01). The period to reach normal serum TSH level was 2.9 months (2.4-4.0) in the LT4 group and 2.8 months (1.9-3.6) in the non-LT4 group (p=0.49). The period decreased during LT4 treatment, as the ratio decreased, but there was no significance (HR 0.15, p=0.10). Conclusion : Elderly SCH patients older than 65 with a serum TSH level ≥ 4.5 mIU/L and < 10.0 mIU/L may consider monitoring their progress every 6 months without using drugs until 18 months when deciding on LT4.
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