Evidence map›Paper›PMID 37656124›Full record

ArticleThe Journal of clinical endocrinology and metabolism2024

Appropriateness of Levothyroxine Prescription: A Multicenter Retrospective Study.

Ivan Nicolas Ayala, Cristian Soto Jacome, David Toro-Tobon, Elizabeth Golembiewski, Andrea Garcia-Bautista, Jessica Hidalgo, Sandra Cordova-Madera, Raghda Al Anbari, Jessica Sohn R, Naykky Singh Ospina and 3 more

Registry-linked trialOpen access · bronzeAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The Journal of clinical endocrinology and metabolism, 2024. 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 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
1.8field-weighted citation impact, top 13% 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 map

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

8 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.

  1. Guideline
  2. Article
  3. Approach to the Patient Considering Thyroid Hormone Deprescribing.The Journal of clinical endocrinology and metabolism · 2026
    Review
  4. Hashimoto's thyroiditis- What's in a name?Hormones (Athens, Greece) · 2025
    Review
  5. Considerations in the Diagnosis and Management of Thyroid Dysfunction in Older Adults.Thyroid : official journal of the American Thyroid Association · 2025
    Review
  6. Article
  7. Article
  8. Appropriateness of Levothyroxine Prescription: A Multicenter Retrospective Study.The Journal of clinical endocrinology and metabolism · 2024
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 6 institutions in 1 country.

Ivan Nicolas AyalaKnowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA.
Cristian Soto JacomeKnowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA.
David Toro-TobonDivision of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA.ORCID 0000-0003-1910-4144
Elizabeth GolembiewskiKnowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA.
Andrea Garcia-BautistaKnowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA.
Jessica HidalgoKnowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA.
Sandra Cordova-MaderaDepartment of Medicine, MetroWest Medical Center, Framingham, MA 01702, USA.
Raghda Al AnbariDivision of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL 32610, USA.
Jessica Sohn RDivision of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL 32610, USA.
Naykky Singh OspinaDivision of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL 32610, USA.ORCID 0000-0001-7229-5061
Spyridoula MarakaDivision of Endocrinology and Metabolism, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Marina JosephDepartment of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Juan P BritoKnowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA.ORCID 0000-0003-1840-1745
Mayo Clinic in Florida · USMayo Clinic in Arizona · USUniversity of Florida · USCentral Arkansas Veterans Healthcare System · USMetroWest Medical Center · USUniversity of Arkansas for Medical Sciences · US

Funding

Expanding Translational Research in ArkansasUL1TR003107 · NCATS · UNIV OF ARKANSAS FOR MED SCIS · PI JAMES, LAURA P · 2019 to 2023
$21.6M
Adequate selection of patients for thyroid biopsy: evaluation of a shared decision making conversation aidK08CA248972 · NCI · UNIVERSITY OF FLORIDA · PI SINGH OSPINA, NAYKKY · 2020 to 2024
$1.1M
Discontinuation of levothyroxine therapy for patients with subclinical hypothyroidism: a pilot randomized, double-blinded, placebo-controlled studyI21HX003268 · VA · CENTRAL ARKANSAS VETERANS HLTHCARE SYS · PI MARAKA, SPYRIDOULA · 2021 to 2022
–
HSRD VA I21 HX003268NCATS NIH HHS UL1 TR003107NCI NIH HHS K08 CA248972
6 · The paper itself

Abstract

contextLevothyroxine is one of the most prescribed medications in the United States.

objectiveThis study explores the appropriateness of levothyroxine prescriptions.

methodsA retrospective multicenter study was conducted on adult patients who were prescribed levothyroxine for the first time between 2017 and 2020 at three academic centers in the United States. We classified each case of levothyroxine initiation into one of three mutually exclusive categories: appropriate (clinically supported), indeterminate (clinically unclear), or nonevidence based (NEB, not clinically supported).

resultsA total of 977 participants were included. The mean age was 55 years (SD 19), there was female (69%) and White race predominance (84%), and 44% had possible hypothyroid symptoms. Nearly half of the levothyroxine prescriptions were considered NEB (528, 54%), followed by appropriate (307, 31%) and indeterminate (118, 12%). The most common reason for NEB prescription was an index thyrotropin (TSH) value of less than 10 mIU/L without previous TSH or thyroxine values (131/528, 25%), for appropriate prescription, was overt hypothyroidism (163/307, 53%), and for an indeterminate prescription was a nonconfirmed subclinical hypothyroidism with TSH greater than or equal to 10 mIU/L (no confirmatory testing) (51/118, 43%). In multivariable analysis, being female (odds ratio [OR]: 1.3; 95% CI, 1.0-1.7) and prescription by a primary care provider (OR: 1.5; 95% CI, 1.2-2.0) were associated with NEB prescriptions.

conclusionThere is a considerable proportion of NEB levothyroxine prescriptions. These results call for additional research to replicate these findings and to explore the perspective of those prescribing and receiving levothyroxine.

Indexed as

HypothyroidismThyroxineAdultFemaleHumansMaleMiddle AgedOdds RatioRetrospective StudiesThyrotropinThyrotropinThyroxine

Identifiers

PMID37656124
PMCPMC10795923
OpenAlexW4386347626

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.