Thyroxine treatment in patients with symptoms of hypothyroidism but thyroid function tests within the reference range: randomised double blind placebo controlled crossover trial.
OBJECTIVE
To determine whether thyroxine treatment is effective in patients with symptoms of hypothyroidism but with thyroid function tests within the reference range, and to investigate the effect of thyroxine treatment on psychological and physical wellbeing in healthy participants.


METHODS
Randomised double blind placebo controlled crossover trial.


METHODS
Outpatient clinic in a general hospital.


METHODS
25 patients with symptoms of hypothyroidism who had thyroid function tests within the reference range, and 19 controls.


METHODS
PARTICIPANTS were given thyroxine 100 microgram or placebo to take once a day for 12 weeks. Washout period was six weeks. They were then given the other to take once a day for 12 weeks. All participants were assessed physiologically and psychologically at baseline and on completion of each phase.


METHODS
Thyroid function tests, measures of cognitive function and of psychological and physical wellbeing.


RESULTS
22 patients and 19 healthy controls completed the study. At baseline, patients' scores on 9 out of 15 psychological measures were impaired when compared with controls. Patients showed a significantly greater response to placebo than controls in 3 out of 15 psychological measures. Healthy participants had significantly lower scores for vitality when taking thyroxine compared to placebo (mean (SD) 60 (17) v 73 (16), P<0.01). However, patients' scores from psychological tests when taking thyroxine were no different from those when taking placebo except for a poorer performance on one visual reproduction test when taking thyroxine. Serum concentrations of free thyroxine increased and those of thyroid stimulating hormone decreased in patients and controls while they were taking thyroxine, confirming compliance with treatment. Although serum concentrations of free triiodothyronine increased in patients and controls taking thyroxine, the difference between the response to placebo and to thyroxine was significant only in the controls.


CONCLUSIONS
Thyroxine was no more effective than placebo in improving cognitive function and psychological wellbeing in patients with symptoms of hypothyroidism but thyroid function tests within the reference range. Thyroxine did not improve cognitive function and psychological wellbeing in healthy participants.
Pollock
M A
MA
Department of Biochemistry, Stobhill Hospital, Glasgow G21 3UW. anne.pollock@northglasgow.scot.nhs.uk
Sturrock
A
A
Marshall
K
K
Davidson
K M
KM
Kelly
C J
CJ
McMahon
A D
AD
McLaren
E H
EH
D000906:Antibodies / Q000097:blood; D002784:Cholesterol / Q000097:blood; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005293:Ferritins / Q000097:blood; D006801:Humans; D007037:Hypothyroidism / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D007453:Iodide Peroxidase / Q000276:immunology; D011388:Prolactin / Q000097:blood; D011581:Psychological Tests; D013960:Thyroid Function Tests; D013961:Thyroid Gland / Q000503:physiopathology; D013972:Thyrotropin / Q000097:blood; D013973:Thyrotropin-Releasing Hormone; D013974:Thyroxine / Q000097:blood / Q000627:therapeutic use*; D017211:Treatment Failure
D000906:Antibodies; D013973:Thyrotropin-Releasing Hormone; D011388:Prolactin; D013972:Thyrotropin; D005293:Ferritins; D002784:Cholesterol; D007453:Iodide Peroxidase; D013974:Thyroxine