Authors' recommendations: An American non-systematic literature review reported that serum T3 measurement has little specificity or sensitivity for diagnosing primary hypothyroidism, since enhanced T4 to T3 conversion maintains T3 concentrations until hypothyroidism becomes severe. No systematic reviews were identified assessing the clinical or cost effectiveness of routine adrenal function testing in the context of primary hypothyroidism. UK guidelines state that tests of adrenal function are mandatory in patients with a high index of suspicion of hypopituitarism. No studies were identified on the diagnostic validity or clinical utility of the adrenal stress index test/adrenal stress profile. A meta-analysis found no statistically significant differences between the clinical effectiveness of combined LT-4+L-T3 therapy and L-T4 monotherapy. In an analysis of patient preference based on five crossover trials, 48% of study participants preferred combined therapy, compared with 27% who preferred L-T4 monotherapy. Only one small trial comparing effectiveness of DTE with L-T4 was identified. There was no evidence of a difference between study periods on symptoms, general wellbeing and cognitive function. A meta-analysis of studies of L-T4 treatment in patients with subclinical hypothyroidism reported no benefit to symptom scores or quality of life. Some small improvements in cardiac function tests were identified although the clinical significance of these is unclear. There was significant heterogeneity across studies and the study authors concluded that treatment should be based on clinical judgment and patient preference. Only one small trial of L-T4 treatment in patients with thyroid function tests within the reference range was identified. Across a battery of tests, clinical benefit of treatment was identified only in a test which assesses memory for non-verbal visual stimuli.

Project Status: Completed

Year Published: 2014

URL for published report: http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/shtg_scoping_reports/technologies_scoping_report_22.aspx

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Scotland, United Kingdom

Organisation Name: Scottish Health Technologies Group

Contact Address: Scottish Health Technologies Group, Delta House, 50 West Nile Street, Glasgow, G1 2NP Tel: 0141 225 6998

Contact Name: his.shtg@nhs.scot

Contact Email: his.shtg@nhs.scot

Copyright: Healthcare Improvement Scotland