British Medical Journal publishes new guideline for subclinical hypothyroidism
BMJ has released a new clinical practice guideline for evaluating benefits and harms of thyroid hormones for adults with subclinical hypothyroidism (SCH), triggered by a recent systematic review of randomised controlled trials, which could lead to a change in current procedure.
The guideline states that thyroid hormones should not be routinely offered to adults with SCH (strong recommendation according to GRADE), thyroid hormones do not lead to important benefits for adults with SCH for quality of life or thyroid related symptoms including depressive symptoms and fatigue and warns that taking a pill and attending periodic testing on an ongoing or lifelong basis is burdensome.
Professor Helen Stokes-Lampard, Chair of the Royal College of GPs added that prescribing is a “core skill for GPs” and they will “always aim to take into account the physical, psychological and social factors potentially affecting a patient before recommending any form of medication – as well as taking into account relevant clinical guidelines.
Thyroid hormones are powerful drugs and GPs will only ever prescribe them if we think they are of genuine benefit to the person sitting in front of us, particularly as it usually means taking the tablets and being monitored in the long-term. If evidence shows that they are not going to be of benefit to our patients, it is important that we know this and that it is reflected in the clinical guidelines that inform our decision-making.
The authors make a powerful case based on emerging evidence, and it is important that this new research is taken on board as clinical guidelines are updated and developed, in the best interests of our patients. It is also important that patients do not suddenly stop taking their thyroxine medication, but that they discuss this with their GP at their next routine medication review.”
SCH affects 4-20% of the adult population. Around 1 in 3 patients with SCH have no symptoms at all, but the type of symptoms people link to SCH include those of overt hypothyroidism: fatigue, muscle cramps, cold sensitivity, dry skin, voice changes, and constipation.