Evidence map›Paper›PMID 31088853›Full record

GuidelineBMJ (Clinical research ed.)2019

Thyroid hormones treatment for subclinical hypothyroidism: a clinical practice guideline.

G E Bekkering, T Agoritsas, L Lytvyn, A F Heen, M Feller, E Moutzouri, H Abdulazeem, B Aertgeerts, D Beecher, J P Brito and 11 more

Registry-linked trialOpen access · bronzeAbstract readPractice Guideline
PubMed Publisher
In one paragraph

Guideline in BMJ (Clinical research ed.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04288115 (Discontinuation of Levothyroxine Therapy for Patients With Subclinical Hypothyroidism), which is not on this map. Cited by 116 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
116citing papers in PubMed, 9 pooled it
19.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04288115 phase4completednot on this mapstarted 2021, after this paper: background citation

Discontinuation of Levothyroxine Therapy for Patients With Subclinical Hypothyroidism: a Pilot Randomized, Double-blinded, Placebo-controlled Study

TypeinterventionalSponsorVA Office of Research and DevelopmentRan2021 to 2022Enrolled52ConditionsSubclinical HypothyroidismArmsLevothyroxine, Placebo
3 · Its place in the literature

Who cites it

116 citing papers in PubMed, 9 syntheses or guidelines pooled it, 226 citations in OpenAlex.

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56 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

21 authors at 14 institutions in 9 countries.

G E BekkeringAcademic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, Belgium trudy.bekkering@kuleuven.be.
T AgoritsasDivision of General Internal Medicine and Division of Clinical Epidemiology, University.
L LytvynDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
A F HeenDepartment of Medicine, Innlandet Hospital Trust-division, Gjøvik, Norway.
M FellerInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
E MoutzouriInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
H AbdulazeemMunich, Germany.
B AertgeertsAcademic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, Belgium.
D BeecherMilan, Italy.
J P BritoKnowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
P D FarhoumandDivision General Internal Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland.
N Singh OspinaDepartment of Medicine, Division of Endocrinology, University of Florida, Gainesville, Florida, USA.
N RodondiInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
M van DrielPrimary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane Qld 4029, Australia.
E WallaceHRB Centre for Primary Care Research and Department of General Practice, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
M SnelDepartment of Endocrinology/General Internal Medicine, Leiden University Medical Center, Leiden, Netherlands.
P M OkwenEffective Basic Services (eBASE), Bamenda, Cameroon.
R SiemieniukDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
P O VandvikInstitute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
T KuijpersDutch College of General Practitioners, Utrecht, Netherlands.
M VermandereAcademic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, Belgium.
Impact · CAInnlandet Hospital Trust · NOKU Leuven · BEUniversity Hospital of Bern · CHBelgian Road Research Centre · BEDutch College of General Practitioners · NLLeiden University Medical Center · NLMcMaster University · CARoyal College of Surgeons in Ireland · IEUniversity Hospital of Geneva · CHUniversity of Bamenda · CMUniversity of Bern · CHUniversity of Florida · USUniversity of Queensland · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

clinical questionWhat are the benefits and harms of thyroid hormones for adults with subclinical hypothyroidism (SCH)? This guideline was triggered by a recent systematic review of randomised controlled trials, which could alter practice. CURRENT PRACTICE: Current guidelines tend to recommend thyroid hormones for adults with thyroid stimulating hormone (TSH) levels >10 mIU/L and for people with lower TSH values who are young, symptomatic, or have specific indications for prescribing. RECOMMENDATION: The guideline panel issues a strong recommendation against thyroid hormones in adults with SCH (elevated TSH levels and normal free T4 (thyroxine) levels). It does not apply to women who are trying to become pregnant or patients with TSH >20 mIU/L. It may not apply to patients with severe symptoms or young adults (such as those ≤30 years old). HOW THIS GUIDELINE WAS CREATED: A guideline panel including patients, clinicians, and methodologists produced this recommendation in adherence with standards for trustworthy guidelines using the GRADE approach. THE EVIDENCE: The systematic review included 21 trials with 2192 participants. For adults with SCH, thyroid hormones consistently demonstrate no clinically relevant benefits for quality of life or thyroid related symptoms, including depressive symptoms, fatigue, and body mass index (moderate to high quality evidence). Thyroid hormones may have little or no effect on cardiovascular events or mortality (low quality evidence), but harms were measured in only one trial with few events at two years' follow-up. UNDERSTANDING THE RECOMMENDATION: The panel concluded that almost all adults with SCH would not benefit from treatment with thyroid hormones. Other factors in the strong recommendation include the burden of lifelong management and uncertainty on potential harms. Instead, clinicians should monitor the progression or resolution of the thyroid dysfunction in these adults. Recommendations are made actionable for clinicians and their patients through visual overviews. These provide the relative and absolute benefits and harms of thyroid hormones in multilayered evidence summaries and decision aids available in MAGIC (https://app.magicapp.org/) to support shared decisions and adaptation of this guideline.

Indexed as

AdultAgedBody Mass IndexDecision MakingDecision Support TechniquesDepressionFatigueFemaleHumansHypothyroidismQuality of LifeThyroid HormonesThyrotropinThyroxineUncertaintyThyroid HormonesThyrotropinThyroxine

Identifiers

PMID31088853
OpenAlexW2945825315

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.