Letter regarding the Paper by Pearce et al. Entitled '2013 ETA Guideline: Management of Subclinical Hypothyroidism'

摘要

In this letter we would like to emphasize a specific part of the new ETA guideline which was explained in the paper by Pearce et al. [1], more specifically the part on thyroid hormone supplementation in the oldest old.In the guideline it is recommended that thyroid hormone supplementation 'should generally be stopped' in the oldest old with a TSH above the normal range but <10 mU/1, but the clinical evidence for this statement is graded as level 3 [i.e. low quality (case series, case reports, expert opinion)]. For this reason, it is also stated that appropriately powered randomized controlled trials of L-thyroxine in patients with subclinical hypothyroidism, examining hard cardiovascular endpoints in various classes of age, are clearly warranted [1]. This recommendation is in line with the latest Cochrane review on this subject [2].