Approach to the Patient Considering Thyroid Hormone Deprescribing

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.