Levothyroxine offers no LVEF benefit in AMI with subclinical hypothyroidism

  • Jabbar A & al.
  • JAMA
  • 21 jul. 2020

  • de Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Levothyroxine yields no left ventricular ejection fraction (LVEF) benefit at 1 year in patients who have had an acute myocardial infarction (AMI) and have subclinical hypothyroidism.

Why this matters

  • The authors say that these preliminary results from a randomized controlled trial (RCT) suggest that screening for and treating subclinical hypothyroidism in these patients “is not justified.”

Key results

  • The treatment and placebo groups were similar for, e.g., mean age (64.1 and 62.9 years), antiplatelet and other therapies, infarct size, and rates of ST-elevation myocardial infarction.
  • LVEF was better (means±standard deviations) in both groups from baseline to 1 year after AMI.
    • With levothyroxine: from 51.3% (9.1%) to 53.8% (9.7%).
    • With placebo: from 54.0% (7.9%) to 56.1% (7.9%).
    • No significant difference.
  • Baseline LVEF was not associated with LVEF outcome.
  • Patient-reported outcomes (e.g., depression scale scores, heart failure questionnaire) did not differ between groups at 1 year.
  • Adverse event rates: 33.3% in the treatment group and 36.7% with placebo.
  • 1 death in each group.

Study design

  • Double-blind RCT, 6 UK hospitals.
  • 46 patients in the levothyroxine and 49 in the placebo group.
  • Primary outcome: LVEF at 52 weeks.
  • Funding: UK National Institute for Health Research.

Limitations

  • Initiation dose was small.
  • LVEF was preserved at baseline in most patients.