Mild hypothyroidism or just getting older?
A synthetic thyroid hormone for hypothyroidism (levothyroxine) was the top prescribed drug in 2015, as determined by the research firm IMS, Medscape reported.
But do that many patients require levothyroxine? And does it help older patients with mild symptoms?
According to Falmouth endocrinologist Angela T. Boldo, MD, those who truly have hypothyroidism do need the drug. But patients with mildly elevated TSH (4 to 10 mIU/L) and normal T3 and T4 hormone levels, a condition known as “subclinical hypothyroidism,” fall into a gray area.
Asymptomatic patients with subclinical hypothyroidism do not require treatment. But the question of whether to treat is when a patient comes to the office with mildly abnormal thyroid test, as in subclinical hypothyroidism, complaining of fatigue, dry skin and hair loss.
“This is very common in seniors and they may be feeling the combined effects of other chronic illnesses they have, the medicines they take or just plain old age,” Dr. Boldo said.
Levothyroxine is prescribed for hypothyroidism and it helps alleviate the symptoms that may include dry skin, thinning hair, fatigue, weight gain, feeling cold, depression or constipation. There were 21.6 million prescriptions for it in 2016, according to Medscape.
“It is definitely overprescribed, specially for those cases of subclinical hypothyroidism, and in most cases, it does not improve the patient’s symptoms, since they were most likely not being caused by their mild decrease in thyroid function,” Dr. Boldo said.
The New England Journal of Medicine in April published a report on a European trial of subclinical hypothyroid patients 65 and older given either levothyroxine or a placebo. The researchers found levothyroxine “had no consistent beneficial effect on thyroid-related symptoms.”
May Be Normal For Seniors
The thyroid gland lies in the front of the neck, with a lobe on either side of the larynx. It regulates the body’s metabolism. An overactive thyroid causes hyperthyroidism, often expressed in nervousness, weight loss and fast heartbeat or atrial fibrillation, according to Harvard Medical School. An underactive thyroid causes hypothyroidism, which can lead to fatigue, hair loss, high cholesterol, a slowed heart rate and even heart failure and coma in severe cases. An elevated TSH level indicates hypothyroidism because TSH, produced by the pituitary gland, increases in the blood as levels of thyroid hormone fall.
A slightly elevated TSH may actually be normal for many seniors, according to Dr. Boldo.
“Most people would not have symptoms at the subclinical thyroid range, but some people are more sensitive,” she said.
Older patients who are suffering, especially from fatigue, often press their doctor for something to ease their symptoms, Dr. Boldo said.
“The doctor’s trying to help – having something they can offer to make the patients feel better,” she said.
Easy To Try
Despite elevated TSH levels often being found in older patients, there is no accepted upward adjustment for a normal TSH range in older patients, Dr. Boldo said. The matter is complicated by the unspecific nature of symptoms associated with mild hypothyroidism.
“Fatigue, dry skin, constipation and hair loss is very common in seniors,” she said. “But the problem is: If you see someone in that borderline range and they have those symptoms, could it be hypothyroidism or not?”
Many times what she suggests is to do a trial of levothyroxine. She explains to the patient that the symptoms might not be from hypothyroidism and if they do not feel any different after taking the medication, they can stop it. She suggests a trial of one to two months in those cases.