TY - JOUR

T1 - Effect of Thyroid Hormone Therapy on Fatigability in Older Adults with Subclinical Hypothyroidism

T2 - A Nested Study within a Randomized Placebo-Controlled Trial

AU - Stuber, Mirah J.

AU - Moutzouri, Elisavet

AU - Feller, Martin

AU - Del Giovane, Cinzia

AU - Bauer, Douglas C.

AU - Blum, Manuel R.

AU - Collet, Tinh Hai

AU - Gussekloo, Jacobijn

AU - Mooijaart, Simon P.

AU - McCarthy, Vera J.C.

AU - Aujesky, Drahomir

AU - Westendorp, Rudi

AU - Stott, David J.

AU - Glynn, Nancy W.

AU - Kearney, Patricia M.

AU - Rodondi, Nicolas

AU - Newman, Anne

PY - 2020

Y1 - 2020

N2 - Background: Fatigue often triggers screening for and treatment of subclinical hypothyroidism. However, data on the impact of levothyroxine on fatigue is limited and previous studies might not have captured all aspects of fatigue. Method: This study is nested within the randomized, placebo-controlled, multicenter TRUST trial, including community-dwelling participants aged =65 and older, with persistent subclinical hypothyroidism (TSH 4.60-19.99 mIU/L, normal free thyroxine levels) from Switzerland and Ireland. Interventions consisted of daily levothyroxine starting with 50 µg (25 µg if weight <50 kg or known coronary heart diseases) together with dose adjustments to achieve a normal TSH and mock titration in the placebo group. Main outcome was the change in physical and mental fatigability using the Pittsburgh Fatigability Scale over 1 year, assessed through multivariable linear regression with adjustment for country, sex, and levothyroxine starting dose. Results: Among 230 participants, the mean ± standard deviation (SD) TSH was 6.2 ± 1.9 mIU/L at baseline and decreased to 3.1 ± 1.3 with LT4 (n = 119) versus 5.3 ± 2.3 with placebo (n = 111, p <. 001) after 1 year. After adjustment we found no between-group difference at 1 year on perceived physical (0.2; 95% CI -1.8 to 2.1; p =. 88), or mental fatigability (-1.0; 95% CI -2.8 to 0.8; p =. 26). In participants with higher fatigability at baseline (=15 points for the physical score [n = 88] or =13 points for the mental score [n = 41]), the adjusted between-group differences at 1 year were 0.4 (95% CI -3.6 to 2.8, p =. 79) and -2.2 (95% CI -8.8 to 4.5, p =. 51). Conclusions: Levothyroxine in older adults with mild subclinical hypothyroidism provides no change in physical or mental fatigability.

AB - Background: Fatigue often triggers screening for and treatment of subclinical hypothyroidism. However, data on the impact of levothyroxine on fatigue is limited and previous studies might not have captured all aspects of fatigue. Method: This study is nested within the randomized, placebo-controlled, multicenter TRUST trial, including community-dwelling participants aged =65 and older, with persistent subclinical hypothyroidism (TSH 4.60-19.99 mIU/L, normal free thyroxine levels) from Switzerland and Ireland. Interventions consisted of daily levothyroxine starting with 50 µg (25 µg if weight <50 kg or known coronary heart diseases) together with dose adjustments to achieve a normal TSH and mock titration in the placebo group. Main outcome was the change in physical and mental fatigability using the Pittsburgh Fatigability Scale over 1 year, assessed through multivariable linear regression with adjustment for country, sex, and levothyroxine starting dose. Results: Among 230 participants, the mean ± standard deviation (SD) TSH was 6.2 ± 1.9 mIU/L at baseline and decreased to 3.1 ± 1.3 with LT4 (n = 119) versus 5.3 ± 2.3 with placebo (n = 111, p <. 001) after 1 year. After adjustment we found no between-group difference at 1 year on perceived physical (0.2; 95% CI -1.8 to 2.1; p =. 88), or mental fatigability (-1.0; 95% CI -2.8 to 0.8; p =. 26). In participants with higher fatigability at baseline (=15 points for the physical score [n = 88] or =13 points for the mental score [n = 41]), the adjusted between-group differences at 1 year were 0.4 (95% CI -3.6 to 2.8, p =. 79) and -2.2 (95% CI -8.8 to 4.5, p =. 51). Conclusions: Levothyroxine in older adults with mild subclinical hypothyroidism provides no change in physical or mental fatigability.

KW - Fatigue

KW - Levothyroxine

KW - Thyroid disease

U2 - 10.1093/gerona/glaa123

DO - 10.1093/gerona/glaa123

M3 - Journal article

C2 - 32577745

AN - SCOPUS:85091191230

VL - 75

SP - e89-e94

JO - Journals of Gerontology. Series A: Biological Sciences & Medical Sciences

JF - Journals of Gerontology. Series A: Biological Sciences & Medical Sciences

SN - 1079-5006

IS - 9

ER -