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Effectiveness of Thyroid Medications: Mayo Clinic Radio

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Dr. Juan Brito Campana, a Mayo Clinic endocrinologist, explains why thyroid medications may be overprescribed in older adults. This interview originally aired June 17, 2017.

Welcome back to mayo clinic radio i’m dr. tom shives and i’m traci mccray do you realize or do you know what the most commonly prescribed medication in the united states is yeah you do but i’ll give you a hint i would have said statins or some sort of antidepressant or anti-anxiety medication that’s what it used to be valium i think was whatever before statins came

Okay you are you gonna guess i wouldn’t even hazard a guess well if you did guess thyroid medication particularly specifically levothyroxine you would be correct i should have guessed that one course you should i believe oh thyroxine is used to treat hypothyroidism your own thyroid gland doesn’t produce enough thyroid hormone 21 and a half million americans take

Levothyroxine including me do you do is get to talk about every well a recent study published in the new england journal of medicine suggests that not all of these people especially older adults are really benefiting from taking it here to discuss thyroid medication is mayo clinic endocrinologist dr. juan brito welcome to the program welcome back to the program

Dr. britto thank you for coming dr. bader good to have you so the recent study suggested that not everyone who is taking thyroid replacement needs to be taken do you agree with that yes i completely agree with that but before we move to the reason why they found that it is important to clarify that there are two kinds of hypothyroidism so the first class is when

You title levels are actually low and in that case giving the medicine makes absolutely sense you’re just replacing what it’s needed your thyroid hormone level is low exactly so the tire is not producing enough it’s producing 80 60 50 40 % so the physician will find that something is abnormal in your blood test and will give you the medicine just to normalize the

Values so that is completely very clear-cut pretty clear-cut the second which is more frequently found at very common is when your thyroid levels are actually normal in your blood but a signal from the brain is high so just in the you brain is sending a signal to the tyro just to tell the tyrell to work more that we call subclinical hypo tidal subclinical yeah

So the prevalence of the common the more frequent hypothyroidism is about 0.2% of the population just a few number of people have the real hypothyroidism but it’s a clinical one in which the levels are normal but a signal coming from the brain’s high is actually in 12 percent of people so this is a large large number so what you’re saying is that those people just

Because the signal is high despite the fact that the hormone level is normal they’re being treated yes the majority of those people get treated so what the study was analyzing is in elderly people who have these subclinical hypothyroidism what was the benefit of giving them thyroid hormone and they analyzed data upon one year and they found that it’s not benefit

From the outcomes that they were measuring wait a second why give that why you do that anyway no matter if they’re elderly or not if their thyroid level is is where it’s rb is normal why would you give a person five-hour medication anyway no matter what their age that’s a very good question and and there there are some triggers of trimming so there are some reasons

Why clinicians are treating these people one of those is that the experts have different opinions about it so different guidelines about the treatment for hypothyroidism might recommend treatment and some others might not recommend any trim it so that is one so conditions get these mixed signals about going to treat how to treat the second one is that the symptoms

Of hypothyroidism the one the really levels are low are very big so they’re fatigued hair loss try skiing weight gain so that they usually happen in normal people with no conditions as they get older i think in order oh you know young people but yes and so imagine that you have the combination of someone complaining of this and someone checking the title just to make

Sure that everything is normal now you find something abnormal in the test and the patient having the symptoms so they tend to come together as oh maybe we should treat as a way to see how hot what happens but when ended up happening is that these patients get the trimming sometimes they don’t feel any benefit but then they never are asked to stop the medicine so

They continues medicine forever and becomes one of the medicines that patients just getting the list and they are difficult to actually step down well that’s what once i have always thought once you’re on levothyroxine you’re on it for the rest of your life exactly so that is a common belief and it’s not accurate it’s not actually true you can actually sometimes

Challenge that by stopping the medicine and see what happens with the levels is there a side effect er there is levothyroxine bad well yes if the dose is is alright it should not have any side effects the typical side effects but the medicine itself has to be taking a specific situation so it has to be taken an empty stomach 45 minutes before breakfast every day

Or your life you have to get it refilled so there are other things that we don’t always considered but there’s something that takes time to do it in terms of everything if the doctor doesn’t get it right all the patients getting it it’s taking the medicine in the wrong way they can actually get the over treatment effect so they can get what we call hyper thyroid

Symptoms which are hyper tumor exactly too much they start feeling the complete opposite shaky palpitations day weight loss symptoms that you know are really really difficult to handle so there is one study for instance they they the study found that almost 50% of elderly people initiated on levothyroxine therapy at one point in therapy they were over treated so

50% and the majority of these people they don’t require thyroid hormone to start with so that is imagine tea is the most prescribed drug in the united states the third most prescribed ragini okay and there is the potential of being over treated with this but not really significant benefits so what should patients do if it’s the most prescribed drug do you just the

Next you have your followup with your general practitioner do you just say can we double check this what should we be doing so one of the things is to make sense of why you are taking this drug so there might be patients that get some benefit and in fact there might be true that even they blood levels are normal there is maybe a threshold in which even though this

The levels are normal the signal from the brain is telling you that’s likely to fail out very soon so he has some pictures actually my benefit of this but they are not the majority so when you are a patient taking limited oxygen it’s important to go back and the reason why you started taking it if the symptoms that were supposed to improve by that did not give any

Better well you are getting your answer already that perhaps the medicine is not for you you might want to step down the medicine reassess in few months and see what the levels are and see what the symptoms are and the same works the same works when you are taking the medicine for the first time just make sense that is the goal and then it’s a horizon when how to

Stop it so i always tell my patients if we’re gonna start this pathway let’s reconvene again in few months and if symptoms have not improved whatsoever well i think the answer is there so the patients really that you’re talking about without making it too complex but expanding a little bit on what you’ve said is you’re talking about the patients who have a normal

Thyroid hormone level but have an elevated tsh thyroid stimulating hormone so the thyroid stimulating hormone being high would suggest that your body is telling your thyroid to produce more hormone hormone but your blood test shows that it in fact is normal so in you’re saying that those patients don’t really need to be treated the majority wishes they don’t but

Again there is a small group of patients in which the signal for the brain the tsh value is rising or going really above above 10 or 20 so very high numbers it’s telling you that it’s very likely that that i would will fail very soon but the majority of patients they don’t have that they just have a slightly abnormal value and to compound everything it seems now

That elderly people people about 65 actually have normal high values of tsh so the brain normally as we age since a higher signal the title alright levothyroxine the most commonly prescribed drug in the united states and you may not need to be taking that thanks so much endocrinologist hormone doctor dr. juan burrito thanks so much thank you for having me

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Effectiveness of Thyroid Medications: Mayo Clinic Radio By Mayo Clinic