Clinical Outcomes After Discontinuation of Thyroid Hormone Replacement - A Systematic Review and Meta-Analysis.

alkiviadis.1961 shared this article with you from Inoreader Clinical Outcomes After Discontinuation of Thyroid Hormone Replacement - A Systematic Review and Meta-Analysis. Via thyroid Related Articles Clinical Outcomes After Discontinuation of Thyroid Hormone Replacement - A Systematic Review and Meta-Analysis. Thyroid. 2020 Nov 09;: Authors: Burgos N, Toloza FJ, Singh Ospina NM, Brito JP, Salloum RG, Hassett LC, Maraka S Abstract BACKGROUND: Levothyroxine (LT4) is one of the most commonly prescribed medications. Although considered a life-long replacement therapy, LT4 therapy can be discontinued for some patients. This study aims to: 1) review the evidence on clinical outcomes of patients undergoing thyroid hormone replacement discontinuation, 2) identify the predictors of successful discontinuation, and 3) systematically appraise frameworks used for deprescribing thyroid hormone. METHODS: We searched multiple bibliographic databases including Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus, from inception to February 2020 for studies in which thyroid hormone replacement was discontinued. Clinical outcomes assessed included: proportion of patients that remained euthyroid or needed to restart thyroid hormone replacement after discontinuation and frequency of clinical symptoms of hypothyroidism and adverse effects. We also evaluated predictors for discontinuation and deprescribing frameworks. Reviewers (FJKT, NB, NSO, SM) evaluated studies for inclusion, extracted data and assessed methodological quality independently and in duplicate. RESULTS: Seventeen observational studies at moderate to high risk of bias met inclusion criteria, including a total of 1105 patients (87% women) with an age range of 5-81 years. Approximately a third of patients undergoing LT4 discontinuation remained euthyroid at follow-up (34.1%, 95% CI: 21.2% - 47.0%, I2 97.5%). Sub-group analysis showed that patients with a previous diagnosis of overt hypothyroidism were less likely to remain euthyroid (11.8%, 95% CI: 4.0%- 23.2%, I2 90.3%) than patients with a prior diagnosis of subclinical hypothyroidism (35.6%, 95% CI: 8.2%- 62.9%, I2 93.5%). No study followed a framework for systematically deprescribing LT4. CONCLUSIONS: Low quality evidence suggests that up to a third of patients remained euthyroid after LT4 discontinuation, with a higher proportion of patients with an initial diagnosis of subclinical hypothyroidism remaining euthyroid than patients with an initial diagnosis of overt hypothyroidism. A deprescribing framework focusing on adequate selection of patients for deprescribing LT4 and a systematic process is warranted to guide clinicians in re-evaluating the need for LT4 in their patients. PMID: 33161885 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.