Thyroid hormone therapy in a population cohort over two decades indicates persistent overtreatment

Area of Science:

• Endocrinology
• Public Health
• Clinical Medicine

Background:

• Thyroid hormones (TH) are widely prescribed, requiring careful monitoring to avoid health risks from over- or undertreatment.
• Cardiovascular morbidity, mortality, and socioeconomic costs are associated with suboptimal TH management.
• Changes in treatment strategies and guidelines over two decades necessitate an evaluation of TH therapy quality and frequency.

Purpose of the Study:

• To investigate trends in the frequency and quality of thyroid hormone (TH) treatment over two decades.
• To assess the impact of evolving treatment concepts and guideline recommendations on TH management.
• To analyze changes in TH prescription rates and thyrotropin (TSH) concentrations in a population-based study.

Main Methods:

• Analysis of data from 7,711 participants in the German Heinz Nixdorf Recall (HNR) study (2000-2023).
• Descriptive analysis of reported thyroid disease, TH therapy prevalence, and TSH concentrations.
• Stratification of analyses by age, sex, and educational attainment.

Main Results:

• Thyroid hormone prescription increased from 9.2% to 15.3% over two decades, while thyroid disease prevalence remained stable.
• TH therapy was more prevalent in women and older individuals.
• Persistent overtreatment was observed, with a significant proportion of participants having low TSH concentrations (<0.45 mIU/L) on TH therapy, particularly the elderly.

Conclusions:

• Thyroid hormone therapy has increased, accompanied by persistent overtreatment, especially in older populations.
• A gap exists between current guideline recommendations and the clinical implementation of TH therapy.
• Improved physician and patient education, restrictive testing, regular treatment review, and age-adjusted dosing are crucial for optimizing TH management.