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Minimal Invasive Resection of Large Retrosternal Thyroid Goiter
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Approach to the Patient Considering Thyroid Hormone Deprescribing.

Spyridoula Maraka1, Maria Papaleontiou2

  • 1Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA.

The Journal of Clinical Endocrinology and Metabolism
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Summary
This summary is machine-generated.

Thyroid hormone overuse is common, but evidence doesn't support its use in mild hypothyroidism. Deprescribing levothyroxine can be safe and effective in select patients when clinically appropriate.

Keywords:
deprescribinghypothyroidismlevothyroxinethyroid hormone

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Area of Science:

  • Endocrinology
  • Pharmacology
  • Internal Medicine

Background:

  • Thyroid hormone overuse, particularly levothyroxine, is increasing.
  • Many patients receive levothyroxine for non-evidence-based indications or mild subclinical hypothyroidism.
  • Levothyroxine initiation lacks proven benefits for patient outcomes in subclinical hypothyroidism and carries risks.

Purpose of the Study:

  • To highlight the issue of unnecessary thyroid hormone treatment.
  • To introduce deprescribing as a strategy to reduce inappropriate levothyroxine use.
  • To present clinical cases illustrating thyroid hormone deprescribing considerations.

Main Methods:

  • Review of current evidence on levothyroxine use and deprescribing.
  • Presentation of three clinical case studies.
  • Discussion of barriers and facilitators to thyroid hormone deprescribing.

Main Results:

  • High-certainty evidence does not support levothyroxine initiation for subclinical hypothyroidism outcomes.
  • Thyroid hormone treatment can lead to patient burden, harm, and costs.
  • Limited data suggest thyroid hormone deprescribing is feasible and safe in selected patients.

Conclusions:

  • Active interventions are needed to reduce unnecessary thyroid hormone treatment.
  • Deprescribing offers a structured approach to safely discontinue inappropriate levothyroxine.
  • A patient-centered, supervised plan is crucial for effective thyroid hormone de-escalation.