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Over- and Undertreatment With Levothyroxine.

Nersi Alaeddin1, Rutchanna M S Jongejan, Julia C Stingl

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Many levothyroxine users experience suboptimal treatment, with 22% being over or undertreated. Older adults are more prone to overtreatment, highlighting the need for careful levothyroxine dosing adjustments.

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Area of Science:

  • Endocrinology
  • Pharmacology
  • Public Health

Background:

  • Levothyroxine is a widely prescribed medication for thyroid conditions.
  • Inadequate treatment, including overtreatment and undertreatment, is a common issue.
  • Limited research exists on the factors influencing suboptimal levothyroxine therapy.

Purpose of the Study:

  • To investigate the prevalence and determinants of inadequate levothyroxine treatment.
  • To analyze factors associated with levothyroxine dosage in a population-based study.

Main Methods:

  • Analysis of data from 2938 participants in the population-based Rhineland Study.
  • Logistic regression used to identify determinants of overtreatment (thyrotropin <0.56 mU/L) and undertreatment (thyrotropin >4.27 mU/L).
  • Linear regression employed to assess determinants of levothyroxine dose.

Main Results:

  • 23% of participants were taking levothyroxine, with 18% overtreated and 4% undertreated.
  • Individuals over 70 were four times more likely to be overtreated (OR = 4.05).
  • Higher levothyroxine doses correlated with increased risk of both overtreatment and undertreatment. Iodine supplementation was linked to lower doses, while longer levothyroxine use correlated with higher doses.

Conclusions:

  • Levothyroxine intake is high but often suboptimal, even with monitoring.
  • Findings emphasize the necessity of precise levothyroxine dosing.
  • Consideration for deintensifying treatment in certain cases is warranted.