It is controversial how to best treat individuals with subclinical hypothyroidism. There is some observational data that it may be associated with increased risk of coronary heart disease but that it may also have a protective role in those ≥ 85 years. This led investigators to establish the TRUST trial.
This was a randomised placebo-controlled clinical trial which recruited 737 adults ≥ 65 years who had persisting subclinical hypothyroidism. Participants were randomised to receive levothyroxine or placebo in a 1:1 ratio. The trial involved successful collaboration across four European countries – Ireland, Scotland, The Netherlands and Switzerland. The Irish site was based in the department of Epidemiology and Public Health in UCC and a large multidisciplinary team led by Professor Patricia Kearney worked on the study. The two primary outcomes were the change in the Hypothyroid Symptoms score and Tiredness score on a thyroid-related quality-of-life questionnaire at 1 year (range of each scale is 0 to 100, with higher scores indicating more symptoms or tiredness respectively). The mean age of the patients was 74.4 years, and 396 patients (53.7%) were women. The median follow-up for all the participants who underwent randomization was 17.3 months.
At 1 year there were no differences in the mean change in the Hypothyroid Symptoms score or the Tiredness score. Based on these findings, the TRUST team concluded that there is now convincing evidence that older people with a mildly underactive thyroid do not get worthwhile benefits from levothyroxine treatment. Professor David Stott from the University of Glasgow, who led the TRUST trial, explains: “Our aim is to significantly improve the health and well-being of older people with subclinical hypothyroidism, by resolving uncertainties about how best to manage this condition. Treatment with levothyroxine is common in clinical practice, but controversial. Our study concludes this treatment provides no apparent benefits for older adults and should therefore no longer be started routinely for this condition. An update of the guidelines is necessary.”
Further information on the TRUST Thyroid Trial can be found on: http://www.trustthyroidtrial.com/index.cfm?p=01BC2BF5-EF26-4B9A-AF9EEB477950C051
Ms. Caroline Hurley, Dr. Anne-Marie O’Flynn and Prof. Patricia Kearney
Department of Epidemiology and Public Health,
University College Cork
If you have any questions or comments please contact Martin on m.davoren@ucc.ie