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Is Long-term Levothyroxine Therapy Safe?

Is Long-term Levothyroxine Therapy Safe? Abstract Our understanding of thyroid hormone action has increased tremendously since 1891, when George Murray1 first successfully treated a hypothyroid patient with sheep thyroid extract injections. As time and experience progressed, we have learned that the thyroid gland synthesizes and secretes two major active components, thyroxine and triiodothyronine. In fact, each of these products has been synthesized and is used now for the treatment of various clinical conditions. Presently, thyroid preparations are prescribed frequently for a variety of common clinical conditions (eg, hypothyroidism, suppression of solitary nodules, or multinodular goiter) See also pp 2077-2081. and, in 1988, accounted for about 1.3% of prescriptions filled in the United States (S. C. Kaufman, MD, T. P. Gross, MD, and D. L. Kennedy, MPH, unpublished data, 1990).2 Endocrinologists are virtually unanimous in recommending synthetic levothyroxine for long-term use, and about 70% of prescriptions written for thyroid preparations in the United States by References 1. Murray GR. Note on the treatment of myxedema by hypodermic injection of an extract of the thyroid gland of a sheep . BMJ . 1891;2:796-797.Crossref 2. National Prescription Audit . Plymouth Meeting, Pa: IMS America Ltd; 1988. 3. Hoffman DA, McConahey WM, Brinton LA, Fraumeni JR Jr. Breast cancer in hypothyroid women using thyroid supplements . JAMA . 1984;251:616-619.Crossref 4. Starr P. Atherosclerosis, hypothyroidism, and thyroid hormone therapy . Adv Lipid Res . 1978;16:345-371. 5. Petersen K, Bengtsson C, Lapidus L, Lindstedt G, Nyström E. Morbidity, mortality, and quality of life for patients treated with levothyroxine . Arch Intern Med . 1990;50:2077-2081.Crossref 6. Bengtsson C, Hallberg L, Hallstrom T, et al. The population of women in Göteburg 1974-1975: the second phase of a longitudinal study: general design, purpose and sampling results . Scand J Soc Med . 1978;6:49-54. 7. Ross DS, Neer RM, Ridgway EC, Daniels GH. Subclinical hyperthyroidism and reduced bone density as a possible result of prolonged suppression of the pituitary thyroid axis with L-thyroxine . Am J Med . 1987;82:1167-1170.Crossref 8. Ross DS. Subclinical hyperthyroidism: possible danger of overzealous thyroxine replacement therapy . Mayo Clinic Proc . 1988;63:1223-1229.Crossref 9. Paul TL, Kerrigan J, Kelly AM, Braverman LE, Baran DT. Long-term L-thyroxine therapy is associated with decreased hip bone density in premenopausal women . JAMA . 1988;259:3137-3141.Crossref 10. Taelman P, Kaufman JM, Janssens X, Vandecauter H, Vermeulen A. Reduced forearm bone mineral content and biochemical evidence of increased bone turnover in women with euthyroid goitre treated with thyroid hormone . Clin Endocrinol . 1990;33:107-117.Crossref 11. Stall GM, Harris S, Sokoll LJ, Dawson-Hughes B. Accelerated bone loss in hypothyroid patients overtreated with L-thyroxine . Ann Intern Med . 1990;113:265-269.Crossref 12. Toh S, Brown P. Bone mineral content in hypothyroid male patients with hormone replacement: a 3-year study . J Bone Miner Res . 1990;5:463-467.Crossref 13. Ahmann AJ, Solomon B, Duncan WE, Wartofsky L. Normal bone mineral density (BMD) in premenopausal women on suppressive doses of L-thyroxine. In: Program and abstracts of the 62nd annual meeting of the American Thyroid Association; September 16-19, 1987; Washington, DC. Abstract 41. 14. Spencer CA, LoPresti JS, Patel A, et al. Applications of a new chemiluminometric thyrotropin assay to subnormal measurement . J Clin Endocrinol Metab . 1990;70:453-460.Crossref 15. Hennessey JV, Evaul JE, Tseng Y-C, Burman KD, Wartofsky L. L-Thyroxine dosage: a reevaluation of therapy with contemporary preparations . Ann Intern Med . 1986;105:11-15.Crossref 16. Ingbar JC, Borges M, Iflah S, Kleinmann RE, Braverman LE, Ingbar SH. Elevated serum thyroxine concentration in patients receiving 'replacement' doses of levothyroxine . J Endocrinol Invest . 1982;5:77-84. 17. Burman KD. Hypothyroidism . In: Rakel RE, ed. Current Therapy . Philadelphia, Pa: WB Saunders Co; 1987:521-528. 18. Rosenbaum RL, Barzel US. Levothyroxine replacement dose for primary hypothyroidism decreases with age . Ann Intern Med . 1982;96:53-55.Crossref 19. Jennings PE, O'Malley BP, Griffin KE, Northover B, Rosenthal FD. Relevance of increased serum thyroxine concentrations associated with normal serum triidothyronine values in hypothyroid patients receiving thyroxine: a case for 'tissue thyrotoxicosis.' BMJ . 1984;289:1645-1647.Crossref 20. Beckett GJ, Kellett HA, Gow SM, Hussey AJ, Hayes JD, Toft AD. Raised plasma glutathione s-transferase values in hyperthyroidism and in hypothyroid patients receiving thyroxine replacement: evidence for hepatic damage . BMJ . 1985;291:427-431.Crossref 21. Carr D, McLeod DT, Parry G, Thornes HM. Fine adjustment of thyroxine replacement dosage: comparison of the thyrotrophin releasing hormone test using a sensitive thyrotrophin assay with measurement of free thyroid hormones and clinical assessment . Clin Endocrinol . 1988;28:325-333.Crossref 22. Watts NB, Harris ST, Genant HK, et al. Intermittent cyclical etidronate treatment of postmenopausal osteoporosis . N Engl J Med . 1990;323:73-79.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Is Long-term Levothyroxine Therapy Safe?

Archives of Internal Medicine , Volume 150 (10) – Oct 1, 1990

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Publisher
American Medical Association
Copyright
Copyright © 1990 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1990.00390210012004
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Abstract

Abstract Our understanding of thyroid hormone action has increased tremendously since 1891, when George Murray1 first successfully treated a hypothyroid patient with sheep thyroid extract injections. As time and experience progressed, we have learned that the thyroid gland synthesizes and secretes two major active components, thyroxine and triiodothyronine. In fact, each of these products has been synthesized and is used now for the treatment of various clinical conditions. Presently, thyroid preparations are prescribed frequently for a variety of common clinical conditions (eg, hypothyroidism, suppression of solitary nodules, or multinodular goiter) See also pp 2077-2081. and, in 1988, accounted for about 1.3% of prescriptions filled in the United States (S. C. Kaufman, MD, T. P. Gross, MD, and D. L. Kennedy, MPH, unpublished data, 1990).2 Endocrinologists are virtually unanimous in recommending synthetic levothyroxine for long-term use, and about 70% of prescriptions written for thyroid preparations in the United States by References 1. Murray GR. Note on the treatment of myxedema by hypodermic injection of an extract of the thyroid gland of a sheep . BMJ . 1891;2:796-797.Crossref 2. National Prescription Audit . Plymouth Meeting, Pa: IMS America Ltd; 1988. 3. Hoffman DA, McConahey WM, Brinton LA, Fraumeni JR Jr. Breast cancer in hypothyroid women using thyroid supplements . JAMA . 1984;251:616-619.Crossref 4. Starr P. Atherosclerosis, hypothyroidism, and thyroid hormone therapy . Adv Lipid Res . 1978;16:345-371. 5. Petersen K, Bengtsson C, Lapidus L, Lindstedt G, Nyström E. Morbidity, mortality, and quality of life for patients treated with levothyroxine . Arch Intern Med . 1990;50:2077-2081.Crossref 6. Bengtsson C, Hallberg L, Hallstrom T, et al. The population of women in Göteburg 1974-1975: the second phase of a longitudinal study: general design, purpose and sampling results . Scand J Soc Med . 1978;6:49-54. 7. Ross DS, Neer RM, Ridgway EC, Daniels GH. Subclinical hyperthyroidism and reduced bone density as a possible result of prolonged suppression of the pituitary thyroid axis with L-thyroxine . Am J Med . 1987;82:1167-1170.Crossref 8. Ross DS. Subclinical hyperthyroidism: possible danger of overzealous thyroxine replacement therapy . Mayo Clinic Proc . 1988;63:1223-1229.Crossref 9. Paul TL, Kerrigan J, Kelly AM, Braverman LE, Baran DT. Long-term L-thyroxine therapy is associated with decreased hip bone density in premenopausal women . JAMA . 1988;259:3137-3141.Crossref 10. Taelman P, Kaufman JM, Janssens X, Vandecauter H, Vermeulen A. Reduced forearm bone mineral content and biochemical evidence of increased bone turnover in women with euthyroid goitre treated with thyroid hormone . Clin Endocrinol . 1990;33:107-117.Crossref 11. Stall GM, Harris S, Sokoll LJ, Dawson-Hughes B. Accelerated bone loss in hypothyroid patients overtreated with L-thyroxine . Ann Intern Med . 1990;113:265-269.Crossref 12. Toh S, Brown P. Bone mineral content in hypothyroid male patients with hormone replacement: a 3-year study . J Bone Miner Res . 1990;5:463-467.Crossref 13. Ahmann AJ, Solomon B, Duncan WE, Wartofsky L. Normal bone mineral density (BMD) in premenopausal women on suppressive doses of L-thyroxine. In: Program and abstracts of the 62nd annual meeting of the American Thyroid Association; September 16-19, 1987; Washington, DC. Abstract 41. 14. Spencer CA, LoPresti JS, Patel A, et al. Applications of a new chemiluminometric thyrotropin assay to subnormal measurement . J Clin Endocrinol Metab . 1990;70:453-460.Crossref 15. Hennessey JV, Evaul JE, Tseng Y-C, Burman KD, Wartofsky L. L-Thyroxine dosage: a reevaluation of therapy with contemporary preparations . Ann Intern Med . 1986;105:11-15.Crossref 16. Ingbar JC, Borges M, Iflah S, Kleinmann RE, Braverman LE, Ingbar SH. Elevated serum thyroxine concentration in patients receiving 'replacement' doses of levothyroxine . J Endocrinol Invest . 1982;5:77-84. 17. Burman KD. Hypothyroidism . In: Rakel RE, ed. Current Therapy . Philadelphia, Pa: WB Saunders Co; 1987:521-528. 18. Rosenbaum RL, Barzel US. Levothyroxine replacement dose for primary hypothyroidism decreases with age . Ann Intern Med . 1982;96:53-55.Crossref 19. Jennings PE, O'Malley BP, Griffin KE, Northover B, Rosenthal FD. Relevance of increased serum thyroxine concentrations associated with normal serum triidothyronine values in hypothyroid patients receiving thyroxine: a case for 'tissue thyrotoxicosis.' BMJ . 1984;289:1645-1647.Crossref 20. Beckett GJ, Kellett HA, Gow SM, Hussey AJ, Hayes JD, Toft AD. Raised plasma glutathione s-transferase values in hyperthyroidism and in hypothyroid patients receiving thyroxine replacement: evidence for hepatic damage . BMJ . 1985;291:427-431.Crossref 21. Carr D, McLeod DT, Parry G, Thornes HM. Fine adjustment of thyroxine replacement dosage: comparison of the thyrotrophin releasing hormone test using a sensitive thyrotrophin assay with measurement of free thyroid hormones and clinical assessment . Clin Endocrinol . 1988;28:325-333.Crossref 22. Watts NB, Harris ST, Genant HK, et al. Intermittent cyclical etidronate treatment of postmenopausal osteoporosis . N Engl J Med . 1990;323:73-79.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 1, 1990

References