Proper diagnosis and adequate treatment are crucial for the management of any disorder. Hypothyroidism is no exception.
However, as the number of patients with thyroid diseases are rapidly growing, doctors and hypothyroid patients are wondering whether they really have hypothyroidism... is it perhaps an over-diagnosed thyroid disorder?
In this article, we will explore whether hypothyroidism is being overtreated and why that could be a problem.
Overtreatment is a common problem
It is first important to address why overtreatment can be a serious problem.
For quite some time, scientists and many healthcare providers expressed their concerns about the overtreatment of many health problems. Studies have also confirmed that overdiagnosis and related overtreatment are increasingly recognized as major problems.
The reason for this is that studies have shown that treatment effects for particular diseases can actually be harmful for those who do not have a disease or disorder. In essence, patients will not get any benefit and may actually suffer from overtreatment of their nonexistent disease. Scientists are continuing research on this effect in order to avoid overtreatment and negative consequences that come with it[i].
What could be behind overtreatment in the United States and worldwide?
A study from the PLoS One found that the most common reasons for overtreatment are malpractice in 84.7% cases, patient pressure or request in 59% cases, and difficulty assessing medical records in 38.2% cases[ii].
In other words, a major reason behind the growing rates of overtreatment is the fact that doctors are afraid of being accused of malpractice.
At the same time, many patients demand prescription medications, even in cases when that is not necessary.
Overtreatment is common, but it can be lowered with a more proactive approach, education, research, and other measures.
Is hypothyroidism overtreated?
As mentioned above, overtreatment has become a common occurrence lately, and it involves many diseases and health conditions.
Hypothyroidism is not an exception.
A recent study warned that hundreds of thousands of patients might be unnecessarily taking prescription medications for their thyroid problems.
An international team of scientists carried out a systematic review which included 21 trials with a total of 2192 participants. Most subjects were over the age of 65.
Results of the study, published in the BMJ, were surprising to many patients and doctors, to say the least.
Scientists discovered that for adults with subclinical hypothyroidism the use of thyroid hormones (standard treatment for this condition) did not demonstrate clinically relevant benefits for quality of life or thyroid-related symptoms including depression, fatigue, and BMI. The same study showed that the treatment for hypothyroidism might have little to no effect on mortality and cardiovascular events as well.
As you likely know, one in 20 people develop hypothyroidism, and this disorder is more common in older people and women, in particular. The standard treatment is regular intake of levothyroxine, a synthetic form of thyroid hormone to make up for the insufficient production of this hormone by the thyroid gland.
The treatment is not temporary - a patient doesn't usually take the pills for a while and then stop. Rather, hypothyroid patients are prescribed lifelong daily pills.
However, the above-mentioned study found that taking a pill every day and attending lifelong checkups is not only burdensome[iii], but may not provide benefits either.
Lifelong treatment may benefit some patients, but not all of them. In other words, this treatment route is not for everybody, so subjecting all patients to the same approach results in overtreatment.
Scientists recommend that it is reasonable for doctors to advise their patients to try thyroid hormone pills for a few months to see how they feel first. That way, it’s possible to avoid committing someone to a lifelong treatment if it’s not necessary.
During the treatment period, doctors would be able to determine whether the patient reacts to the pills or not. As a result, there would be no need to subject someone to pills that don’t work for them.
Do I have to stop taking my medications?
While hypothyroidism may be overtreated, patients should never increase or decrease the dosage on their own.
Additionally, patients should not stop taking medications whenever they feel like. Instead, make sure you consult your healthcare provider[iv], express your concerns, and ask for advice.
Your doctor will take into account the symptoms you experience, whether they’re improving or worsening, as well as your concerns before advising you whether to stop taking medications or decrease the dosage.
Scientists advise clinicians to monitor the progression or resolution of the thyroid dysfunction in the patients.
Check your weight regularly
One of the hallmark symptoms of hypothyroidism is weight gain.
A patient’s weight plays a role in the treatment of this condition since the dosage of thyroid hormone is based on a patient’s weight.
In addition to the weight, doctors also monitor thyroid hormone levels in blood tests because some patients experience difficulties with absorption.
A useful way to avoid overtreatment of hypothyroidism is to check your weight regularly. Make sure you report weight gain or weight loss of 10% or higher to your doctor.
That way, your doctor would be able to adjust the dosage of thyroid hormone more adequately.
Focus on thyroid status, not prescriptions
Earlier in the post, we have discussed some major factors that lead to overtreatment.
One of those factors is that doctors are afraid of being accused of malpractice, while the second factor is that the patients request prescriptions.
The constant desire for pills has put patients at a situation where they could be put into a negative situation.
Patients often get alarmed by normal and abnormal TSH levels listed on some websites. But you need to bear in mind those values usually refer only to specific age ranges. For instance, what is considered normal for a 30-year-old person may not be okay for someone who is 60. Using those values as a reference (especially if age is not mentioned) may be a source of confusion and stress.
At the same time, age is only one of the various factors that doctors use to evaluate whether a patient may benefit from hormone replacement therapy or not.
Other factors include overall clinical situation, history of symptoms, comorbidities, physical examination, other medications a patient may be taking, just to name a few.
Doctors focus on overall thyroid status in order to decide whether to give you a prescription for levothyroxine, another thyroid treatment, or not.
If the above-mentioned factors and thyroid status do not reveal the necessity for treatment, the doctor will not prescribe it.
At the same time, patients should not focus on prescriptions only[v]. Lack of prescription does not need to be a bad thing.
It may save you from overtreatment.
Since many patients have the habit of seeking prescriptions thinking they won't feel better without them, you need to trust your healthcare provider and adopt lifestyle modifications they recommend.
Your doctor should give you a few pointers regarding lifestyle changes you need to make in order to improve health and function of your thyroid and thereby manage symptoms and improve your quality of life in a natural way, without having to take pills.
Don’t diagnose yourself
The internet allows people to look up just about any information online and learn something, and then they go into the doctor's office convinced they have a certain health problem and demand a prescription to treat it.
But just because some symptoms exist, it doesn't mean you do have that health problem. Let's take hypothyroidism as an example.
This condition is indicated by weight gain, temperature sensitivity, hair loss, moodiness, sleeplessness, and other symptoms.
However, you need to keep in mind that many conditions can share symptoms. Therefore, even if you think that you have hypothyroidism that may not be the case.
Persons who experience hypothyroidism-related symptoms should see the doctor who will recommend certain tests in order to rule out other conditions and make an accurate diagnosis. Diagnosis and hormone levels, as well as the above-mentioned factors, allow doctors to recommend adequate treatment.
Diagnosing yourself and pushing for prescriptions can lead to overtreatment, which is the last thing both you and your doctor want. Doctors should stay away from prescribing lifelong medications and giving in under pressure to prescribe pills even when it's not necessary.
Overtreatment is a common problem nowadays across the globe.
Factors behind overtreatment are numerous, including the fear of malpractice and patients' demands for prescriptions.
Studies show that hypothyroidism is often overtreated, as well. Many patients do not benefit from the treatment, which makes the lifelong intake of pills burdensome.
It is recommended that clinicians prescribe pills for a certain period of time only and monitor patient's condition, symptoms, and hormone levels prior to deciding whether to stop or prolong treatment.
This does not mean hypothyroid patients should stop taking medications instantly.
Consult your doctor, follow their advice, and don't push for prescriptions if there is no need for it.
[i]. Moynihan, R., Henry, D., & Moons, K. G. (2014). Using evidence to combat overdiagnosis and overtreatment: evaluating treatments, tests, and disease definitions in the time of too much. PLoS medicine, 11(7), e1001655. doi:10.1371/journal.pmed.1001655. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4077659/
[ii] Lyu, H., Xu, T., Brotman, D., Mayer-Blackwell, B., Cooper, M., Daniel, M., … Makary, M. A., (2017). Overtreatment in the United States. PloS one, 12(9), e0181970. doi:10.1371/journal.pone.0181970. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587107/
[iv]Cleveland Clinic, (2014). Underactive Thyroid: Is Yours Being Overtreated?. Retrieved from: https://health.clevelandclinic.org/underactive-thyroid-is-yours-being-overtreated/
[v] Tired? Always cold? Think it's hypothyroidism? Think again. EndocrineWeb. Retrieved from: https://www.endocrineweb.com/news/thyroid-diseases/61567-tired-always-cold-think-its-hypothyroidism-think-again