Mayo Clinic endocrinologist Dr. Juan Brito says, while some people genuinely need the hormone replacement to regulate metabolism and ward off health risks, most people taking it do not. Dr. Brito says each prescription should be accompanied by thorough follow-up care. "What is important is to engage the patient and the doctor, and make sure they have a reason to [take] it and a plan – what to do if symptoms don't get better and what to do if the symptoms do get better."   Dennis Douda has more in this Mayo Clinic Radio Health Minute.

To listen, click the link below.

Over-prescribed levothyroxine

The post Over-prescribed levothyroxine: Mayo Clinic Radio Health Minute appeared first on Mayo Clinic News Network.

ANSWER: Yes. Make an appointment to have your condition re-evaluated at this time. For some people, lifelong treatment of hypothyroidism with the drug levothyroxine is necessary. But studies have found that for many others who have elevated levels of thyroid-stimulating hormone, or TSH, the medication isn’t needed. In fact, if it’s taken incorrectly or in doses that are too large, levothyroxine can cause harmful side effects.

Your thyroid is a small, butterfly-shaped gland at the base of the front of your neck. The thyroid gland makes two hormones — triiodothyronine, or T3, and thyroxine, or T4 — that have a large impact on your health, affecting all aspects of your metabolism. They maintain the rate at which your body uses fats and carbohydrates, help control your body temperature, influence your heart rate, and help regulate the production of proteins. The rate at which your thyroid makes T3 and T4 is regulated by another hormone that your pituitary gland produces, called TSH.

Hypothyroidism, sometimes called underactive thyroid, is a condition in which your thyroid gland doesn't produce enough T3 or T4. When blood tests show that you have high levels of TSH and low levels of T3 or T4 in your body, then a diagnosis of hypothyroidism is clear. Treatment with levothyroxine — a synthetic version of thyroid hormones — is necessary in almost all cases. But hypothyroidism is rare, affecting only about 0.2 percent of the population.

Much more common, affecting about 12 percent of the population, is a condition known as subclinical hypothyroidism. With this condition, your TSH level is above normal, but T3 and T4 levels are normal.

If a blood test shows you have subclinical hypothyroidism, and you don’t have any symptoms — such as fluid retention, fatigue, increased sensitivity to cold, constipation, muscle weakness or painful joints — treatment typically is not recommended. There are a few reasons for that.

First, about 30 percent of people whose condition falls into the category of subclinical hypothyroidism have their TSH levels return to normal within one year without treatment. Only 3 percent per year go on to develop hypothyroidism. Second, if you take too much levothyroxine or if you don’t take it correctly, it can negatively affect a variety of your body’s systems, including your brain, heart and muscle function. It also can interfere with how your body handles fluid and fats.

If, as in your case, you are receiving treatment for hypothyroidism, it’s important to have regular checkups. Testing TSH is one way to see if treatment is working. It’s also important for your health care provider to check your T4 levels.

Talk with your health care provider about the goals of treatment, too. If you started taking levothyroxine to control symptoms, make sure that you are seeing some benefit. Also, keep in mind that the symptoms of hypothyroidism often can be vague. If your symptoms don’t go away when you’re taking thyroid medication, it’s possible those symptoms could be linked to another medical condition.

Getting your TSH and T4 levels checked and reviewing any symptoms you may have with your health care provider should help clarify whether you need to continue taking levothyroxine. — Dr. Juan Brito Campana, Endocrinology, Mayo Clinic, Rochester, Minnesota

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On the next Mayo Clinic Radio program, Dr. Deborah Lightner, a Mayo Clinic urologist, will discuss options for preventing and treating urinary incontinence. Also on the program, Dr. James Naessens, a researcher at the Kern Center for the Science of Health Care Delivery, will share findings on the importance of getting a second opinion. And Dr. Juan Brito Campana, a Mayo Clinic endocrinologist, will explain why thyroid medications may be overprescribed in older adults.

Here's the Mayo Clinic Radio podcast.

The post Female urinary incontinence: Mayo Clinic Radio appeared first on Mayo Clinic News Network.

Urinary incontinence is the loss of bladder control, resulting in the accidental loss of urine. Due to pregnancy, childbirth, menopause and the structure of the female urinary tract, women are twice as likely as men to suffer from urinary incontinence. While urinary incontinence might be only slightly bothersome for some, it can be totally debilitating for others. For some women, the chance of embarrassment keeps them from enjoying many physical activities, including exercising. But, the good news is that effective treatments are available for treating urinary incontinence if women are willing to discuss it with their health care provider.

On the next Mayo Clinic Radio program, Dr. Deborah Lightner, a Mayo Clinic urologist, will discuss options for preventing and treating urinary incontinence. Also on the program, Dr. James Naessens, a researcher at the Kern Center for the Science of Health Care Delivery, will share findings on the importance of getting a second opinion. And Dr. Juan Brito Campana, a Mayo Clinic endocrinologist, will explain why thyroid medications may be overprescribed in older adults.

To hear the program, find an affiliate in your area.

Follow #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

The post Mayo Clinic Radio: Female urinary incontinence appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Deborah Lightner, a Mayo Clinic urologist, will discuss options for preventing and treating urinary incontinence. Also on the program, Dr. James Naessens, a researcher at the Kern Center for the Science of Health Care Delivery, will share findings on the importance of getting a second opinion. And Dr. Juan Brito Campana, a Mayo Clinic endocrinologist, will explain why thyroid medications may be overprescribed in older adults.

To hear the program, find an affiliate in your area.

Miss the show?  Here's the Mayo Clinic Radio podcast.

Follow #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

The post Mayo Clinic Radio: Female urinary incontinence / value of a second opinion / thyroid medication in older adults appeared first on Mayo Clinic News Network.

In the case of thyroid-stimulating hormone (TSH), pregnant women typically produce a lower level than normal (0.4–4.0 milli-international units per liter). Some international guidelines recommend levels be no higher than 2.5–3. milli-international units per liter during pregnancy. When their TSH levels rise above this, they may experience subclinical hypothyroidism, or mildly underactive thyroid, which can cause a number of health problems if left untreated.

Today, Mayo Clinic researchers report that one of those results could be pregnancy loss. Researchers further suggest a course of action that could positively impact as many as 15 of every 100 pregnancies. In a study published in The BMJ, they show that treating subclinical hypothyroidism (not quite the level that would be treated in a nonpregnant woman) can reduce pregnancy loss, especially for those with TSH levels on the upper end of normal or higher.

“A recent analysis of 18 studies showed that pregnant women with untreated subclinical hypothyroidism are at higher risk for pregnancy loss, placental abruption, premature rupture of membranes, and neonatal death,” says Spyridoula Maraka, M.D., an endocrinologist and lead author of the study. “It seemed likely that treating subclinical hypothyroidism would reduce the chance of these deadly occurrences. But we know that treatment brings other risks, so we wanted to find the point at which benefits outweighed risks.”

Using the OptumLabs Data Warehouse, Dr. Maraka and her team examined the health information of 5,405 pregnant women diagnosed with subclinical hypothyroidism. Of these, 843 women, with an average pretreatment TSH concentration of 4.8 milli-international units per liter, were treated with thyroid hormone. The remaining 4,562, with an average pretreatment TSH concentration of 3.3 milli-international units per liter, were not treated.

MEDIA CONTACT: Sharon Theimer, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

Compared with the untreated group, treated women were 38 percent less likely to experience pregnancy loss. However, they were more likely to have a preterm delivery, or experience gestational diabetes or preeclampsia.

The team also looked at the levels of pretreatment TSH to determine if there was a point when treatment would have the most positive overall effect.

“Unsurprisingly, we found that women with higher levels of pre-treatment TSH—between 4.1 and 10 milli-international units per liter —benefitted most from treatment,” says Dr. Maraka. “This group’s much lower likelihood of experiencing pregnancy loss was what brought the average down – and creates a good argument for updated clinical guidelines.”

The researchers found that, for women with lower levels of TSH (2.5–4.0  milli-international units per liter), the risk of gestational hypertension (which can lead to preeclampsia) was significantly higher for treated women than for untreated women. There was no difference between treated women who had the higher levels of TSH (4.1–10 milli-international units per liter) and untreated women.

“Our findings lead us to believe that overtreatment could be possible,” says Juan Brito Campana, M.B.B.S., a Mayo Clinic endocrinologist and study co-author. “If the TSH levels are in that 2.5–4.0 [milli-international units per liter] range, it may be best to leave subclinical hypothyroidism untreated.”

The team found no other adverse outcomes that appeared affected by different pretreatment TSH levels and subsequent thyroid hormone use.

Dr. Brito Campana further says that the association of levothyroxine therapy (drug used to treat hypothyroidism) and the risk of pregnancy-related adverse outcomes (e.g., preeclampsia or gestational diabetes) should be seen as preliminary findings and should call for additional studies evaluating the safety of levothyroxine therapy in pregnant women with subclinical hypothyroidism.

The results and recommendations in this study seem somewhat prophetic. On Jan. 6, 2017, the American Thyroid Association published updated care guidelines with treatment recommendations for women experiencing thyroid disease during pregnancy.

“These guidelines can help women and their doctors decide together what will be best for them,” says Dr. Brito.

“We are pleased to see them and remain committed to further medical research and refinement of available information to assist in shared decision-making and improved health.”

This research was made possible by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, using the OptumLabs Data Warehouse. This data consists of retrospective administrative claims data, including medical claims and eligibility information from a large national U.S. health insurance plan, as well as electronic health record data from a nationwide network of provider groups. It is a resource of OptumLabs, a collaborative research and innovation center cofounded by Mayo Clinic and Optum in 2013. The research was conducted in collaboration with Mayo Clinic’s Knowledge and Evaluation Research Unit. This unit focuses much of its efforts on developing and validating shared decision aids across all of health care. Dr. Maraka is a research collaborator in the unit.

In addition to her work at Mayo Clinic, Dr. Maraka works in the Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences, and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas.

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