Levothyroxine is one of the most commonly prescribed medications in the US, and nearly two thirds of these patients don't actually need to be taking it! In this episode, Drs. Bobby Scott and Sandy Robertson review the evidence to find out which patients, if any, with subclinical hypothyroidism should be treated.
Also, Dr. Dawn Caviness interviews our first guest, Cabarrus Family Medicine Chief Resident, Dr. Macy Osborn as she tells us whether we should be doing routine bimanual exams.
CORRECTION: At 05:49, it should be noted that overt hypothyroidism is where TSH is high and T4 is low, rather than both values being low as was mistakenly stated in the recording.
Episode outline:
- How many patients take levothyroxine for subclinical hypothyroidism? 03:35
- Rationale behind treating these patients 07:18
- Evidence surrounding treatment of subclinical hypothyroidism 09:10
- Potential harms of treatment 16:20
- The bottom line: when do we treat patients with subclinical hypothyroidism? 17:27
- Should we be doing routine bimanual exams? 21:53
Links from this episode:
- Subclinical hypothyroidism and CV risk: https://pubmed.ncbi.nlm.nih.gov/20858880/
- Levothyroxine does not improve quality of life and thyroid-related symptoms in SCH: https://pubmed.ncbi.nlm.nih.gov/30285179/
- BMJ guideline on treatment of SCH: https://pubmed.ncbi.nlm.nih.gov/31088853/
- Does SCH add any symptoms?: https://pubmed.ncbi.nlm.nih.gov/33872585/
- Levothyroxine does not improve symptoms in older adults with SCH: https://pubmed.ncbi.nlm.nih.gov/32365355/
- Levothyroxine does not improve symptoms in adults aged 80+ with SCH: https://pubmed.ncbi.nlm.nih.gov/31664429/
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Credits:
- Hosts: Bobby Scott, MD, FAAFP; Sandy Robertson, PharmD; Dawn Caviness, MD, BSN
- Production & Cover Art: Bobby Scott, MD, FAAFP
- Music: Twisterium, MondayHopes, Muzaproduction, and SergeQuadrado from Pixabay
