Levothyroxine treatment response of cardiometabolic biomarkers in older adults with subclinical hypothyroidism.
Ao Linjun, Noordam Raymond, Trompet Stella, van Vliet Nicolien A, Sattar Naveed, Rodondi Nicolas, Moutzouri Elisavet, Atighetchi Sarah, Kearney Patricia M, Quinn Terry, Jukema J Wouter, Gussekloo Jacobijn, Mooijaart Simon P, Willems van Dijk Ko, Poortvliet Rosalinde K E, van Heemst Diana
The Journal of clinical endocrinology and metabolism · 2026 · PMID 41965091 · 인용 2
CONTEXT: Randomized controlled trials (RCTs) found no cardioprotective effects of levothyroxine therapy in older adults with subclinical hypothyroidism.
OBJECTIVE: The aim of this study was to assess levothyroxine effects on cardiometabolic biomarkers, which may serve as more sensitive treatment indicators.
DESIGN: Post-hoc analysis using (baseline and 12-month) data from two double-blind RCTs in older adults (≥65 years) with subclinical hypothyroidism. MAIN OUTCOME MEASURE(S): Cardiometabolic biomarkers included seven clinically relevant lipid measures (apolipoprotein B (ApoB), total cholesterol (Total-C), non-high-density lipoprotein cholesterol (non-HDL-C), remnant cholesterol (RC), low-density lipoprotein cholesterol (LDL-C), HDL-C, and triglycerides (TG)) and 167 standardized metabolomic measures from nuclear magnetic resonance. Analyses were additionally stratified by baseline TSH levels.
RESULTS: Among 286 included participants (48% women; median age 75 [70, 82] years; median baseline TSH 6.44 [5.36, 7.81] mIU/L), 142 were randomized to levothyroxine. Overall, levothyroxine showed no effects on ApoB (-0.03 [95% CI: -0.07, 0.00] g/L), Total-C (-0.17 [-0.34, 0.00] mmol/L), non-HDL-C (-0.15 [-0.31, 0.00] mmol/L), RC (-0.09 [-0.16, -0.01] mmol/L), LDL-C (-0.07 [-0.15, 0.02] mmol/L), and TG (-0.07 [-0.15, 0.01] mmol/L). In participants with baseline TSH ≥10 mIU/L (n = 27), potentially beneficial changes (P < .05, but not significant after multiple-testing correction) were observed for all clinically relevant lipids except HDL-C, as well as for ApoB-containing lipoproteins, VLDL size, and fatty acids.
CONCLUSION: In older adults with subclinical hypothyroidism, levothyroxine treatment showed no effects on cardiometabolic biomarkers, although potentially favorable changes in lipids and lipoproteins were observed for individuals with baseline TSH ≥10 mIU/L.