Impact of Thyroid Hormone Therapy on Atherosclerosis in the Elderly with Subclinical Hypothyroidism: A Randomized Trial.

Context

Subclinical hypothyroidism (SHypo) has been associated with atherosclerosis, but no conclusive clinical trials assessing the levothyroxine impact on carotid atherosclerosis exist.

Objective

To assess the impact of treatment of SHypo with levothyroxine on carotid atherosclerosis.

Design/Setting

Randomized, double-blind, placebo-controlled trial nested within the TRUST trial.

Participants

Participants aged ≥65 years with SHypo (thyroid-stimulating hormone, TSH, 4.60-19.99 mIU/L; free thyroxine level within reference range).

Intervention

Levothyroxine dose-titrated to achieve TSH normalization, or placebo including mock titrations.

Main Outcome Measures

Carotid intima media thickness (CIMT), maximum plaque thickness measured with ultrasound.

Results

185 participants (mean age 74.1 years, 47% women, 96 randomized to levothyroxine) underwent carotid ultrasound. Overall mean TSH±SD was 6.35±1.95 mIU/L at baseline and decreased to 3.55±2.14 mIU/L with levothyroxine, as compared to 5.29±2.21 mIU/L with placebo (p<0.001). After a median treatment of 18.4 months (interquartile range 12.2-30.0 months), mean CIMT was 0.85±0.14 mm under levothyroxine and 0.82±0.13 mm under placebo (between-group difference=0.02 mm, 95% confidence interval (CI)-0.01 to 0.06, p=0.30). Proportion of carotid plaque was similar (n=135, 70.8% under levothyroxine and 75.3% under placebo, p=0.46). Maximum carotid plaque thickness was 2.38±0.92 mm under levothyroxine and 2.37±0.91 mm under placebo (between-group difference -0.03, 95%CI -0.34 to 0.29, p=0.86). There were no significant interactions between levothyroxine treatment and mean CIMT according to sex, baseline TSH (categories 4.6-6.9, 7.0-9.9, and ≥10mmol/L) or established cardiovascular disease (all p for interaction ≥0.14).

Conclusion

Normalization of TSH with levothyroxine was associated with no difference in CIMT and carotid atherosclerosis in older persons with SHypo.