There is a need for new guidelines regarding the treatment of mildly underactive thyroid gland among senior citizens says professor at the University of Copenhagen, after a new study has shown that the most popular treatment of the condition has no effect. In fact, senior citizens would benefit more from accepting the condition or waiting for it to pass.

Today senior citizens with a mildly underactive thyroid gland are often treated with the component levothyroxine, which forms part of the most prescribed drug in the US and the third most prescribed drug in the UK. However, it can be a good idea to wait before commencing treatment, as a new international study published in The New England Journal of Medicine shows that the drug has no effect. At worst, it can cause side effects caused by an inappropriately high level of thyroid hormone.

‘Our study shows that senior citizens are currently being over–treated. Many risk being treated with a drug they have no use for. We know that the body to a great extent is able to regulate itself, and if we allow the body time to work, most people will take a turn for the better without the use of drugs’, says Professor Rudi Westendorp from the Center for Healthy Aging at the University of Copenhagen, who, together with researchers from four other universities – University of Glasgow in Scotland, Leiden University in the Netherlands, University Hospital of Bern in Switzerland and University College Cork in Ireland – is behind the new study.

The study titled ’Thyroid Hormone Replacement for Subclinical Hypothyroidism Trial (TRUST)’ has taken five years to conduct and followed 737 senior citizens. Half of the senior citizens received placebo treatment, while the rest were treated with levothyroxin tablets. The two groups experienced the same symptoms, even though the medicated group showed a higher level of the hormone thyroidea in the blood.

"We know that it is far better for senior citizens to have a low rather than a high level of thyroid hormone. It is therefore vital that we do not per routine treat people with a drug that has no effect and, at worst, causes their condition to deteriorate. It is about time we take a critical look at the international guidelines for the area and adjust them to ensure that senior citizens receive the right treatment," says Professor Rudi Westendorp, who hopes the results will make the world acknowledge the need for more independent research into the health of senior citizens.

A main tool for the researchers in the project has been their method for examining the symptoms of the senior citizens involved. Here the researchers have used a new tool developed in Denmark, a so–called patient–reported outcome instrument, which is a quality of life questionnaire that has helped them gain knowledge of the symptoms and health of the senior citizens and enabled them for the first time to document the treatment’s lack of effect.

"I would like to stress that the intention with the study has not been to point fingers. On the contrary, we want to make it absolutely clear that it can be a good idea to wait before commencing treatment. When a patient goes to see his doctor with symptoms that may be a sign of a mildly underactive thyroid gland, it can be a good idea for the doctor to wait and see if the condition passes on its own before prescribing medication. This way we can ensure that the medicine is only given to patients who actually benefit from it. Others may need something completely different in their lives to improve the symptoms that made them go to the doctor," says Doctor and PhD Torquil Watt from the Department of Medical Endocrinology at Rigshospitalet, who has developed the questionnaire and also participated in the new study.