Additional treatment strategies for hypothyroidism: a network meta-analysis

Area of Science:

• Endocrinology
• Metabolic Diseases
• Exercise Physiology

Background:

• Hypothyroidism frequently diminishes patients' quality of life (QoL).
• Standard treatment with levothyroxine (LT4) may not fully restore QoL for all patients.
• Additional therapeutic interventions are being explored to optimize hypothyroidism management.

Purpose of the Study:

• To conduct a network meta-analysis (NMA) evaluating the efficacy and safety of interventions additional to levothyroxine (LT4) for hypothyroidism.
• To compare various treatment combinations against placebo and LT4 monotherapy.

Main Methods:

• A systematic search of PubMed, Embase, Cochrane Library, and Web of Science for randomized controlled trials (RCTs) on hypothyroidism treatment.
• Bayesian network meta-analysis (NMA) to calculate standardized mean differences (SMD) and risk ratios (RR) with 95% credible intervals (CrIs).
• Assessment of evidence certainty using the CINeMA framework.

Main Results:

• Levothyroxine (LT4) + aerobic training (AT) + resistance training (RT) significantly reduced TSH (SMD = -3.97) with high certainty.
• LT4 + zinc (Zn) + magnesium (Mg) + vitamin A (VA) increased free thyroxine (FT4) (SMD = 1.95) with high certainty.
• LT4 + AT + RT significantly improved QoL (SMD = 1.62) and mental health scores (MHS) (SMD = 2.1) compared to LT4 alone.
• Liothyronine (LT3) was associated with increased adverse events (RR = 15.54) with very low certainty.

Conclusions:

• The combination of LT4 with AT and RT emerges as a potentially preferred strategy for managing hypothyroidism.
• This combined approach may effectively reduce TSH, improve QoL, and enhance MHS.
• Treatment decisions should be individualized based on patient-specific profiles and needs.