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Richter C, Wildisen L, Rohrmann S, Haile SR. Better tools for better estimates: improving approaches to handling missing data in Swiss cancer registries. Eur J Cancer Prev 2024:00008469-990000000-00134. [PMID: 38457243 DOI: 10.1097/cej.0000000000000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
OBJECTIVE Various approaches have been used in the literature to handle missing vital status data in cancer registries. We aimed to compare these approaches to determine which led to the least biased estimates in typical analytic tasks of cancer registries. METHODS A simulation study was performed using data from the Swiss National Agency for Cancer Registration for six tumor types. First, 5%, 10% and 15% missingness in the vital status were introduced artificially in the complete data. Second, missing vital status data were handled by applying no, single or multiple imputations. Five-year overall survival estimates, relative survival or standardized incidence ratio were computed. Estimates were compared with the true value. RESULTS Standardized incidence ratio estimates for colorectal cancer obtained with multiple imputation yielded least biased results (-0.06 to -0.04), but the widest confidence intervals. Single imputation was more biased (-0.32) than using no imputation at all (-0.21). A similar pattern was observed for overall survival and relative survival. CONCLUSION This simulation study indicated that often used single imputation (sometimes referred to as simulating follow-up times) techniques to fill in missing vital status data are likely too biased to be useful in practice. Multiple imputation approaches yielded standardized incidence ratio, overall and relative survival estimates with the least bias, indicating reasonable performance that is likely to generalize to other settings.
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Affiliation(s)
- Cornelia Richter
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich
- National Institute for Cancer Epidemiology and Registration (NICER)
- National Agency for Cancer Registration (NACR), Zurich, Switzerland
| | - Lea Wildisen
- National Institute for Cancer Epidemiology and Registration (NICER)
- National Agency for Cancer Registration (NACR), Zurich, Switzerland
| | - Sabine Rohrmann
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich
- National Institute for Cancer Epidemiology and Registration (NICER)
| | - Sarah R Haile
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich
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2
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Xu Y, Derakhshan A, Hysaj O, Wildisen L, Ittermann T, Pingitore A, Abolhassani N, Medici M, Kiemeney LALM, Riksen NP, Dullaart RPF, Trompet S, Dörr M, Brown SJ, Schmidt B, Führer-Sakel D, Vanderpump MPJ, Muendlein A, Drexel H, Fink HA, Ikram MK, Kavousi M, Rhee CM, Bensenor IM, Azizi F, Hankey GJ, Iacoviello M, Imaizumi M, Ceresini G, Ferrucci L, Sgarbi JA, Bauer DC, Wareham N, Boelaert K, Bakker SJL, Jukema JW, Vaes B, Iervasi G, Yeap BB, Westendorp RGJ, Korevaar TIM, Völzke H, Razvi S, Gussekloo J, Walsh JP, Cappola AR, Rodondi N, Peeters RP, Chaker L. The optimal healthy ranges of thyroid function defined by the risk of cardiovascular disease and mortality: systematic review and individual participant data meta-analysis. Lancet Diabetes Endocrinol 2023; 11:743-754. [PMID: 37696273 PMCID: PMC10866328 DOI: 10.1016/s2213-8587(23)00227-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/05/2023] [Accepted: 07/25/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Reference intervals of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) are statistically defined by the 2·5-97·5th percentiles, without accounting for potential risk of clinical outcomes. We aimed to define the optimal healthy ranges of TSH and FT4 based on the risk of cardiovascular disease and mortality. METHODS This systematic review and individual participant data (IPD) meta-analysis identified eligible prospective cohorts through the Thyroid Studies Collaboration, supplemented with a systematic search via Embase, MEDLINE (Ovid), Web of science, the Cochrane Central Register of Controlled Trials, and Google Scholar from Jan 1, 2011, to Feb 12, 2017 with an updated search to Oct 13, 2022 (cohorts found in the second search were not included in the IPD). We included cohorts that collected TSH or FT4, and cardiovascular outcomes or mortality for adults (aged ≥18 years). We excluded cohorts that included solely pregnant women, individuals with overt thyroid diseases, and individuals with cardiovascular disease. We contacted the study investigators of eligible cohorts to provide IPD on demographics, TSH, FT4, thyroid peroxidase antibodies, history of cardiovascular disease and risk factors, medication use, cardiovascular disease events, cardiovascular disease mortality, and all-cause mortality. The primary outcome was a composite outcome including cardiovascular disease events (coronary heart disease, stroke, and heart failure) and all-cause mortality. Secondary outcomes were the separate assessment of cardiovascular disease events, all-cause mortality, and cardiovascular disease mortality. We performed one-step (cohort-stratified Cox models) and two-step (random-effects models) meta-analyses adjusting for age, sex, smoking, systolic blood pressure, diabetes, and total cholesterol. The study was registered with PROSPERO, CRD42017057576. FINDINGS We identified 3935 studies, of which 53 cohorts fulfilled the inclusion criteria and 26 cohorts agreed to participate. We included IPD on 134 346 participants with a median age of 59 years (range 18-106) at baseline. There was a J-shaped association of FT4 with the composite outcome and secondary outcomes, with the 20th (median 13·5 pmol/L [IQR 11·2-13·9]) to 40th percentiles (median 14·8 pmol/L [12·3-15·0]) conveying the lowest risk. Compared with the 20-40th percentiles, the age-adjusted and sex-adjusted hazard ratio (HR) for FT4 in the 80-100th percentiles was 1·20 (95% CI 1·11-1·31) for the composite outcome, 1·34 (1·20-1·49) for all-cause mortality, 1·57 (1·31-1·89) for cardiovascular disease mortality, and 1·22 (1·11-1·33) for cardiovascular disease events. In individuals aged 70 years and older, the 10-year absolute risk of composite outcome increased over 5% for women with FT4 greater than the 85th percentile (median 17·6 pmol/L [IQR 15·0-18·3]), and men with FT4 greater than the 75th percentile (16·7 pmol/L [14·0-17·4]). Non-linear associations were identified for TSH, with the 60th (median 1·90 mIU/L [IQR 1·68-2·25]) to 80th percentiles (2·90 mIU/L [2·41-3·32]) associated with the lowest risk of cardiovascular disease and mortality. Compared with the 60-80th percentiles, the age-adjusted and sex-adjusted HR of TSH in the 0-20th percentiles was 1·07 (95% CI 1·02-1·12) for the composite outcome, 1·09 (1·05-1·14) for all-cause mortality, and 1·07 (0·99-1·16) for cardiovascular disease mortality. INTERPRETATION There was a J-shaped association of FT4 with cardiovascular disease and mortality. Low concentrations of TSH were associated with a higher risk of all-cause mortality and cardiovascular disease mortality. The 20-40th percentiles of FT4 and the 60-80th percentiles of TSH could represent the optimal healthy ranges of thyroid function based on the risk of cardiovascular disease and mortality, with more than 5% increase of 10-year composite risk identified for FT4 greater than the 85th percentile in women and men older than 70 years. We propose a feasible approach to establish the optimal healthy ranges of thyroid function, allowing for better identification of individuals with a higher risk of thyroid-related outcomes. FUNDING None.
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Affiliation(s)
- Yanning Xu
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Arash Derakhshan
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ola Hysaj
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Lea Wildisen
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Till Ittermann
- Institute for Community Medicine, Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research, Partner site Greifswald, Greifswald, Germany
| | | | | | - Marco Medici
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Lambertus A L M Kiemeney
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department for Health Evidence, Nijmegen, Netherlands
| | - Niels P Riksen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Robin P F Dullaart
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Stella Trompet
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, the Netherlands
| | - Marcus Dörr
- German Centre for Cardiovascular Research, Partner site Greifswald, Greifswald, Germany; Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Suzanne J Brown
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Dagmar Führer-Sakel
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment, Feldkirch, Austria
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment, Feldkirch, Austria; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein; Drexel University College of Medicine, Philadelphia, PA, USA
| | - Howard A Fink
- Geriatric Research Education and Clinical Center, VA Healthcare System, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Connie M Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, USA
| | - Isabela M Bensenor
- Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Graeme J Hankey
- The University of Western Australia, Perth, WA, Australia; Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Massimo Iacoviello
- Cardiology Unit, Cardiothoracic Department, University Polyclinic Hospital of Bari, Bari, Italy
| | - Misa Imaizumi
- Department of Clinical Studies, Radiation Effects Research Foundation, Nagasaki, Japan
| | - Graziano Ceresini
- Department of Medicine and Surgery, Unit of Internal Medicine and Onco-Endocrinology, University Hospital of Parma, Parma, Italy
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, USA
| | - José A Sgarbi
- Division of Endocrinology and Metabolism, Faculdade de Medicina de Marília, Marília, Brazil
| | - Douglas C Bauer
- Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Nick Wareham
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Kristien Boelaert
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, the Netherlands; Netherlands Heart Institute, Utrecht, Netherlands
| | - Bert Vaes
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Giorgio Iervasi
- National Research Council Institute of Clinical Physiology, Pisa, Italy
| | - Bu B Yeap
- The University of Western Australia, Perth, WA, Australia; Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia
| | - Rudi G J Westendorp
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Tim I M Korevaar
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Henry Völzke
- Institute for Community Medicine, Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research, Partner site Greifswald, Greifswald, Germany
| | - Salman Razvi
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jacobijn Gussekloo
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, the Netherlands; Department of Public Health and Primary Care, Leiden University Medical Center, the Netherlands
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; The University of Western Australia, Perth, WA, Australia
| | - Anne R Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Nicolas Rodondi
- Institute of Primary Health Care, University of Bern, Bern, Switzerland; Department of General Internal Medicine, Inselspital, University of Bern, Switzerland
| | - Robin P Peeters
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Layal Chaker
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands.
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3
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Netzer S, Chocano-Bedoya P, Feller M, Janett-Pellegri C, Wildisen L, Büchi AE, Moutzouri E, Rodriguez EG, Collet TH, Poortvliet RKE, Mc Carthy VJC, Aeberli D, Aujesky D, Westendorp R, Quinn TJ, Gussekloo J, Kearney PM, Mooijaart S, Bauer DC, Rodondi N. The effect of thyroid hormone therapy on muscle function, strength and mass in older adults with subclinical hypothyroidism-an ancillary study within two randomized placebo controlled trials. Age Ageing 2023; 52:7008632. [PMID: 36721961 DOI: 10.1093/ageing/afac326] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND loss of skeletal muscle function, strength and mass is common in older adults, with important socioeconomic impacts. Subclinical hypothyroidism is common with increasing age and has been associated with reduced muscle strength. Yet, no randomized placebo-controlled trial (RCT) has investigated whether treatment of subclinical hypothyroidism affects muscle function and mass. METHODS this is an ancillary study within two RCTs conducted among adults aged ≥65 years with persistent subclinical hypothyroidism (thyrotropin (TSH) 4.60-19.99 mIU/l, normal free thyroxine). Participants received daily levothyroxine with TSH-guided dose adjustment or placebo and mock titration. Primary outcome was gait speed at final visit (median 18 months). Secondary outcomes were handgrip strength at 1-year follow-up and yearly change in muscle mass. RESULTS we included 267 participants from Switzerland and the Netherlands. Mean age was 77.5 years (range 65.1-97.1), 129 (48.3%) were women, and their mean baseline TSH was 6.36 mIU/l (standard deviation [SD] 1.9). At final visit, mean TSH was 3.8 mIU/l (SD 2.3) in the levothyroxine group and 5.1 mIU/l (SD 1.8, P < 0.05) in the placebo group. Compared to placebo, participants in the levothyroxine group had similar gait speed at final visit (adjusted between-group mean difference [MD] 0.01 m/s, 95% confidence interval [CI] -0.06 to 0.09), similar handgrip strength at one year (MD -1.22 kg, 95% CI -2.60 to 0.15) and similar yearly change in muscle mass (MD -0.15 m2, 95% CI -0.49 to 0.18). CONCLUSIONS in this ancillary analysis of two RCTs, treatment of subclinical hypothyroidism did not affect muscle function, strength and mass in individuals 65 years and older.
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Affiliation(s)
- Seraina Netzer
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Patricia Chocano-Bedoya
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Population Health Laboratory, University of Fribourg, Fribourg, Switzerland
| | - Martin Feller
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Camilla Janett-Pellegri
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Lea Wildisen
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Annina E Büchi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Elisavet Moutzouri
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Elena Gonzalez Rodriguez
- Interdisciplinary Center for Bone Diseases, Service of Rheumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Tinh-Hai Collet
- Service of Endocrinology, Diabetes, Nutrition and Therapeutic Education, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Rosalinde K E Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | | | - Daniel Aeberli
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rudi Westendorp
- Department of Public Health, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Section Gerontology and Geriatrics, University of Leiden, Leiden, Netherlands.,Department of Internal Medicine, Section Gerontology and Geriatrics, University of Leiden, Leiden, Netherlands
| | | | - Simon Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Douglas C Bauer
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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4
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Syrogiannouli L, Wildisen L, Meuwese C, Bauer DC, Cappola AR, Gussekloo J, den Elzen WPJ, Trompet S, Westendorp RGJ, Jukema JW, Ferrucci L, Ceresini G, Åsvold BO, Chaker L, Peeters RP, Imaizumi M, Ohishi W, Vaes B, Völzke H, Sgarbi JA, Walsh JP, Dullaart RPF, Bakker SJL, Iacoviello M, Rodondi N, Del Giovane C. Incorporating Baseline Outcome Data in Individual Participant Data Meta-Analysis of Non-randomized Studies. Front Psychiatry 2022; 13:774251. [PMID: 35273528 PMCID: PMC8902696 DOI: 10.3389/fpsyt.2022.774251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In non-randomized studies (NRSs) where a continuous outcome variable (e.g., depressive symptoms) is assessed at baseline and follow-up, it is common to observe imbalance of the baseline values between the treatment/exposure group and control group. This may bias the study and consequently a meta-analysis (MA) estimate. These estimates may differ across statistical methods used to deal with this issue. Analysis of individual participant data (IPD) allows standardization of methods across studies. We aimed to identify methods used in published IPD-MAs of NRSs for continuous outcomes, and to compare different methods to account for baseline values of outcome variables in IPD-MA of NRSs using two empirical examples from the Thyroid Studies Collaboration (TSC). METHODS For the first aim we systematically searched in MEDLINE, EMBASE, and Cochrane from inception to February 2021 to identify published IPD-MAs of NRSs that adjusted for baseline outcome measures in the analysis of continuous outcomes. For the second aim, we applied analysis of covariance (ANCOVA), change score, propensity score and the naïve approach (ignores the baseline outcome data) in IPD-MA from NRSs on the association between subclinical hyperthyroidism and depressive symptoms and renal function. We estimated the study and meta-analytic mean difference (MD) and relative standard error (SE). We used both fixed- and random-effects MA. RESULTS Ten of 18 (56%) of the included studies used the change score method, seven (39%) studies used ANCOVA and one the propensity score (5%). The study estimates were similar across the methods in studies in which groups were balanced at baseline with regard to outcome variables but differed in studies with baseline imbalance. In our empirical examples, ANCOVA and change score showed study results on the same direction, not the propensity score. In our applications, ANCOVA provided more precise estimates, both at study and meta-analytical level, in comparison to other methods. Heterogeneity was higher when change score was used as outcome, moderate for ANCOVA and null with the propensity score. CONCLUSION ANCOVA provided the most precise estimates at both study and meta-analytic level and thus seems preferable in the meta-analysis of IPD from non-randomized studies. For the studies that were well-balanced between groups, change score, and ANCOVA performed similarly.
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Affiliation(s)
| | - Lea Wildisen
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Christiaan Meuwese
- Department of Intensive Care Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Douglas C Bauer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Anne R Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Jacobijn Gussekloo
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Wendy P J den Elzen
- Atalmedial Diagnostics Centre, Amsterdam, Netherlands.,Department of Clinical Chemistry, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, Netherlands
| | - Stella Trompet
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Rudi G J Westendorp
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands.,Netherlands Heart Institute, Utrecht, Netherlands
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, United States
| | - Graziano Ceresini
- Unit of Internal Medicine and Onco-Endocrinology, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Bjørn O Åsvold
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Layal Chaker
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands.,Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands.,Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Misa Imaizumi
- Department of Clinical Studies, Radiation Effects Research Foundation, Nagasaki, Japan
| | - Waka Ohishi
- Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Henry Völzke
- Institute for Community Medicine, Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany
| | - Josè A Sgarbi
- Division of Endocrinology and Metabolism, Department of Medicine, Faculdade de Medicina de Marilia, São Paulo, Brazil
| | - John P Walsh
- Medical School, The University of Western Australia, Crawley, WA, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Robin P F Dullaart
- Department of Internal Medicine, University Medical Center, University of Groningen, Groningen, Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center, University of Groningen, Groningen, Netherlands
| | - Massimo Iacoviello
- Cardiology Unit, University Hospital Policlinico Consorziale of Bari, Bari, Italy
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
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5
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Janett-Pellegri C, Wildisen L, Feller M, Del Giovane C, Moutzouri E, Grolimund O, Walter P, Waeber G, Marques-Vidal P, Vollenweider P, Rodondi N. Prevalence and factors associated with chronic use of levothyroxine: A cohort study. PLoS One 2021; 16:e0261160. [PMID: 34928965 PMCID: PMC8687586 DOI: 10.1371/journal.pone.0261160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/25/2021] [Indexed: 11/19/2022] Open
Abstract
Importance Levothyroxine prescriptions are rising worldwide. However, there are few data on factors associated with chronic use. Objective To assess the prevalence of chronic levothyroxine use, its rank among other chronic drugs and factors associated with chronic use. To assess the proportion of users outside the therapeutic range of thyroid-stimulating hormone (TSH). Design Cohort study (CoLaus|PsyCoLaus) with recruitment from 2003 to 2006. Follow-ups occurred 5 and 10 years after baseline. Participants A random sample of Lausanne (Switzerland) inhabitants aged 35–75 years. Main outcomes We evaluated the prevalence of chronic levothyroxine use and we then ranked it among the other most used chronic drugs. The ranking was compared to data from health insurance across the country. We assessed the association between each factor and chronic levothyroxine use in multivariable logistic regression models. The proportion of chronic levothyroxine users outside the usual TSH therapeutic range was assessed. Results 4,334 participants were included in the analysis (mean±SD age 62.8±10.4 years, 54.9% women). 166 (3.8%) participants were chronic levothyroxine users. Levothyroxine was the second most prescribed chronic drug after aspirin in the cohort (8.2%) and the third most prescribed when using Swiss-wide insurance data. In multivariable analysis, chronic levothyroxine use was associated with increasing age [odds ratio 1.03, 95% confidence interval 1.01–1.05 per 1-year increase]; female sex [11.87 (5.24–26.89)]; BMI [1.06 (1.02–1.09) per 1-kg/m2 increase]; number of concomitant drugs [1.22 (1.16–1.29) per 1-drug increase]; and family history of thyroid pathologies [2.18 (1.37–3.48)]. Among chronic levothyroxine users with thyroid hormones assessment (n = 157), 42 (27%) were outside the TSH therapeutic range (17% overtreated and 10% undertreated). Conclusions In this population-based study, levothyroxine ranked second among chronic drugs. Age, female sex, BMI, number of drugs and family history of thyroid pathologies were associated with chronic levothyroxine use. More than one in four chronic users were over- or undertreated.
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Affiliation(s)
- Camilla Janett-Pellegri
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Lea Wildisen
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Martin Feller
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Elisavet Moutzouri
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | | | - Gérard Waeber
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- * E-mail:
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6
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Ipekci AM, Buitrago-Garcia D, Meili KW, Krauer F, Prajapati N, Thapa S, Wildisen L, Araujo-Chaveron L, Baumann L, Shah S, Whiteley T, Solís-García G, Tsotra F, Zhelyazkov I, Imeri H, Low N, Counotte MJ. Outbreaks of publications about emerging infectious diseases: the case of SARS-CoV-2 and Zika virus. BMC Med Res Methodol 2021; 21:50. [PMID: 33706715 PMCID: PMC7948668 DOI: 10.1186/s12874-021-01244-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Outbreaks of infectious diseases generate outbreaks of scientific evidence. In 2016 epidemics of Zika virus emerged, and in 2020, a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a pandemic of coronavirus disease 2019 (COVID-19). We compared patterns of scientific publications for the two infections to analyse the evolution of the evidence. METHODS We annotated publications on Zika virus and SARS-CoV-2 that we collected using living evidence databases according to study design. We used descriptive statistics to categorise and compare study designs over time. RESULTS We found 2286 publications about Zika virus in 2016 and 21,990 about SARS-CoV-2 up to 24 May 2020, of which we analysed a random sample of 5294 (24%). For both infections, there were more epidemiological than laboratory science studies. Amongst epidemiological studies for both infections, case reports, case series and cross-sectional studies emerged first, cohort and case-control studies were published later. Trials were the last to emerge. The number of preprints was much higher for SARS-CoV-2 than for Zika virus. CONCLUSIONS Similarities in the overall pattern of publications might be generalizable, whereas differences are compatible with differences in the characteristics of a disease. Understanding how evidence accumulates during disease outbreaks helps us understand which types of public health questions we can answer and when.
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Affiliation(s)
- Aziz Mert Ipekci
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Diana Buitrago-Garcia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | | | - Fabienne Krauer
- Centre for Ecological and Evolutionary Synthesis (CEES), University of Oslo, Oslo, Norway
| | - Nirmala Prajapati
- École des Hautes Études en Santé Publique (EHESP), Saint Denis, France
| | - Shabnam Thapa
- Institute of Public Health, Jagiellonian University Medical College, Kraków, Poland
| | - Lea Wildisen
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | - Lukas Baumann
- Department of Internal Medicine, Kantonsspital Olten, Olten, Switzerland
| | - Sanam Shah
- École des Hautes Études en Santé Publique (EHESP), Saint Denis, France
| | - Tessa Whiteley
- École des Hautes Études en Santé Publique (EHESP), Saint Denis, France
| | - Gonzalo Solís-García
- Pediatrics Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Foteini Tsotra
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Ivan Zhelyazkov
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Hira Imeri
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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7
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Wildisen L, Feller M, Del Giovane C, Moutzouri E, Du Puy RS, Mooijaart SP, Collet TH, Poortvliet RKE, Kearney P, Quinn TJ, Klöppel S, Bauer DC, Peeters RP, Westendorp R, Aujesky D, Gussekloo J, Rodondi N. Effect of Levothyroxine Therapy on the Development of Depressive Symptoms in Older Adults With Subclinical Hypothyroidism: An Ancillary Study of a Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2036645. [PMID: 33566107 PMCID: PMC7876592 DOI: 10.1001/jamanetworkopen.2020.36645] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Previous trials on the effect of levothyroxine on depressive symptom scores in patients with subclinical hypothyroidism were limited by small sample sizes (N = 57 to 94) and potential biases. OBJECTIVE To assess the effect of levothyroxine on the development of depressive symptoms in older adults with subclinical hypothyroidism in the largest trial on this subject and to update a previous meta-analysis including the results from this study. DESIGN, SETTING, AND PARTICIPANTS This predefined ancillary study analyzed data from participants in the Thyroid Hormone Replacement for Untreated Older Adults with Subclinical Hypothyroidism (TRUST) trial, a double-blind, randomized, placebo-controlled, parallel-group clinical trial conducted from April 2013 to October 31, 2016. The TRUST trial included adults aged 65 years or older diagnosed with subclinical hypothyroidism, defined as the presence of persistently elevated thyroid-stimulating hormone (TSH) levels (4.6-19.9 mIU/L) with free thyroxine (T4) within the reference range. Participants were identified from clinical and general practitioner laboratory databases and recruited from the community in Switzerland, the Netherlands, Ireland, and the UK. This ancillary study included a subgroup of 472 participants from the Netherlands and Switzerland; after exclusions, a total of 427 participants (211 randomized to levothyroxine and 216 to placebo) were analyzed. This analysis was conducted from December 1, 2019, to September 1, 2020. INTERVENTIONS Randomization to either levothyroxine or placebo. MAIN OUTCOMES AND MEASURES Depressive symptom scores after 12 months measured with the Geriatric Depression Scale (GDS-15), with higher scores indicating more depressive symptoms (minimal clinically important difference = 2). RESULTS A total of 427 participants with subclinical hypothyroidism (mean [SD] age, 74.52 [6.29] years; 239 women [56%]) were included in this analysis. The mean (SD) TSH level was 6.57 (2.22) mIU/L at baseline and decreased after 12 months to 3.83 (2.29) mIU/L in the levothyroxine group; in the placebo group, it decreased from 6.55 (2.04) mIU/L to 5.91 (2.66) mIU/L. At baseline, the mean (SD) GDS-15 score was 1.26 (1.85) in the levothyroxine group and 0.96 (1.58) in the placebo group. The mean (SD) GDS-15 score at 12 months was 1.39 (2.13) in the levothyroxine and 1.07 (1.67) in the placebo group with an adjusted between-group difference of 0.15 for levothyroxine vs placebo (95% CI, -0.15 to 0.46; P = .33). In a subgroup analysis including participants with a GDS-15 of at least 2, the adjusted between-group difference was 0.61 (95% CI, -0.32 to 1.53; P = .20). Results did not differ according to age, sex, or TSH levels. A previous meta-analysis (N = 278) on the association of levothyroxine with depressive symptoms was updated to include these findings, resulting in an overall standardized mean difference of 0.09 (95% CI, -0.05 to 0.22). CONCLUSIONS AND RELEVANCE This ancillary study of a randomized clinical trial found that depressive symptoms did not differ after levothyroxine therapy compared with placebo after 12 months; thus, these results do not provide evidence in favor of levothyroxine therapy in older persons with subclinical hypothyroidism to reduce the risk of developing depressive symptoms. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01853579.
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Affiliation(s)
- Lea Wildisen
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Martin Feller
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Elisavet Moutzouri
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Robert S. Du Puy
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Simon P. Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Tinh-Hai Collet
- Service of Endocrinology, Diabetology, Nutrition, and Therapeutic Education, Geneva University Hospitals, Geneva, Switzerland
| | | | | | - Terence J. Quinn
- Institute of Cardiovascular Medicine, University of Glasgow, Glasgow, Scotland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
| | - Douglas C. Bauer
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Robin P. Peeters
- Department of Medicine, Erasmus Medical Center, Rotterdam, the Netherland
| | - Rudi Westendorp
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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8
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Wildisen L, Del Giovane C, Moutzouri E, Beglinger S, Syrogiannouli L, Collet TH, Cappola AR, Åsvold BO, Bakker SJL, Yeap BB, Almeida OP, Ceresini G, Dullaart RPF, Ferrucci L, Grabe H, Jukema JW, Nauck M, Trompet S, Völzke H, Westendorp R, Gussekloo J, Klöppel S, Aujesky D, Bauer D, Peeters R, Feller M, Rodondi N. An individual participant data analysis of prospective cohort studies on the association between subclinical thyroid dysfunction and depressive symptoms. Sci Rep 2020; 10:19111. [PMID: 33154486 PMCID: PMC7644764 DOI: 10.1038/s41598-020-75776-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 10/20/2020] [Indexed: 01/07/2023] Open
Abstract
In subclinical hypothyroidism, the presence of depressive symptoms is often a reason for starting levothyroxine treatment. However, data are conflicting on the association between subclinical thyroid dysfunction and depressive symptoms. We aimed to examine the association between subclinical thyroid dysfunction and depressive symptoms in all prospective cohorts with relevant data available. We performed a systematic review of the literature from Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library from inception to 10th May 2019. We included prospective cohorts with data on thyroid status at baseline and depressive symptoms during follow-up. The primary outcome was depressive symptoms measured at first available follow-up, expressed on the Beck's Depression Inventory (BDI) scale (range 0-63, higher values indicate more depressive symptoms, minimal clinically important difference: 5 points). We performed a two-stage individual participant data (IPD) analysis comparing participants with subclinical hypo- or hyperthyroidism versus euthyroidism, adjusting for depressive symptoms at baseline, age, sex, education, and income (PROSPERO CRD42018091627). Six cohorts met the inclusion criteria, with IPD on 23,038 participants. Their mean age was 60 years, 65% were female, 21,025 were euthyroid, 1342 had subclinical hypothyroidism and 671 subclinical hyperthyroidism. At first available follow-up [mean 8.2 (± 4.3) years], BDI scores did not differ between participants with subclinical hypothyroidism (mean difference = 0.29, 95% confidence interval = - 0.17 to 0.76, I2 = 15.6) or subclinical hyperthyroidism (- 0.10, 95% confidence interval = - 0.67 to 0.48, I2 = 3.2) compared to euthyroidism. This systematic review and IPD analysis of six prospective cohort studies found no clinically relevant association between subclinical thyroid dysfunction at baseline and depressive symptoms during follow-up. The results were robust in all sensitivity and subgroup analyses. Our results are in contrast with the traditional notion that subclinical thyroid dysfunction, and subclinical hypothyroidism in particular, is associated with depressive symptoms. Consequently, our results do not support the practice of prescribing levothyroxine in patients with subclinical hypothyroidism to reduce the risk of developing depressive symptoms.
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Affiliation(s)
- Lea Wildisen
- grid.5734.50000 0001 0726 5157Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland ,grid.5734.50000 0001 0726 5157Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Cinzia Del Giovane
- grid.5734.50000 0001 0726 5157Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Elisavet Moutzouri
- grid.5734.50000 0001 0726 5157Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland ,grid.5734.50000 0001 0726 5157Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Shanthi Beglinger
- grid.5734.50000 0001 0726 5157Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland ,grid.5734.50000 0001 0726 5157Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Lamprini Syrogiannouli
- grid.5734.50000 0001 0726 5157Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Tinh-Hai Collet
- grid.8515.90000 0001 0423 4662Service of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Anne R. Cappola
- grid.25879.310000 0004 1936 8972Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104 USA
| | - Bjørn O. Åsvold
- grid.5947.f0000 0001 1516 2393K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Postboks 8905 MTFS, 7491 Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Postbox 3250 Torgarden, 7006 Trondheim, Norway
| | - Stephan J. L. Bakker
- grid.4830.f0000 0004 0407 1981Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Bu B. Yeap
- grid.1012.20000 0004 1936 7910Medical School, University of Western Australia Perth, The University of Western Australia (M582), 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Osvaldo P. Almeida
- grid.1012.20000 0004 1936 7910Medical School, University of Western Australia Perth, The University of Western Australia (M582), 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Graziano Ceresini
- grid.411482.aDepartment of Medicine and Surgery, Unit of Internal Medicine and Onco-Endocrinology, University Hospital of Parma, Via Gramsci, 14 - 43126 Parma, Italy
| | - Robin P. F. Dullaart
- grid.4830.f0000 0004 0407 1981Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Luigi Ferrucci
- grid.419475.a0000 0000 9372 4913Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, 251 Bayview Boulevard, Suite 100, Baltimore, MD 21224 USA
| | - Hans Grabe
- grid.5603.0Institute for Community Medicine, Clinical-Epidemiological Research, University Medicine Greifswald, Walter Rathenau Str. 48, 17475 Greifswald, Germany
| | - J. Wouter Jukema
- grid.10419.3d0000000089452978Department of Cardiology, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, The Netherlands
| | - Matthias Nauck
- grid.5603.0Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Stella Trompet
- grid.10419.3d0000000089452978Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Henry Völzke
- grid.5603.0Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Ellernholzstrasse 1-2, 17489 Greifswald, Germany
| | - Rudi Westendorp
- grid.5254.60000 0001 0674 042XDepartment of Public Health and Center for Healthy Aging, University of Copenhagen, Gothersgade 160, 1123 København K, Mærsk Tower, Copenhagen, Denmark
| | - Jacobijn Gussekloo
- grid.10419.3d0000000089452978Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands ,grid.10419.3d0000000089452978Department of Public Health and Primary Care, Leiden University Medical Center, LUMC Education Building, Hippocratespad 21, 2333 ZD Leiden, the Netherlands
| | - Stefan Klöppel
- grid.5734.50000 0001 0726 5157University Hospital of Old Age Psychiatry, University of Bern, Murtenstrasse 21, 3008 Bern, Switzerland
| | - Drahomir Aujesky
- grid.5734.50000 0001 0726 5157Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Douglas Bauer
- grid.266102.10000 0001 2297 6811Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, 550 16th St., Box 0560, San Francisco, CA 94158 USA
| | - Robin Peeters
- grid.5645.2000000040459992XDepartment of Medicine, Erasmus Medical Center, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - Martin Feller
- grid.5734.50000 0001 0726 5157Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland ,grid.5734.50000 0001 0726 5157Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Nicolas Rodondi
- grid.5734.50000 0001 0726 5157Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland ,grid.5734.50000 0001 0726 5157Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
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Wildisen L, Del Giovane C, Feller M, Moutzouri E, Mooijaart S, Poortvliet R, Du Puy R, Peeters R, Gussekloo J, Rodondi N. The effect of levothyroxine therapy on depressive symptoms in adults with subclinical hypothyroidism. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Levothyroxine is one of the most commonly prescribed drugs. A common reason for levothyroxine treatment on patients with subclinical hypothyroidism are depressive symptoms. A meta-analysis of four RCTs (n = 278) found no benefit of levothyroxine therapy on depressive symptoms. However, the confidence interval does not exclude a small clinical benefit. We aim to assess the effect of levothyroxine therapy for depressive symptoms in patients with subclinical hypothyroidism using data from a RCT with more than 400 adults.
Methods
The TRUST trial was a double-blind, randomized, placebo-controlled trial involving adults aged ≥65y with subclinical hypothyroidism (elevated TSH levels (4.6-19.9 mU/L) and free thyroxine within the reference range). The outcome was depressive symptoms after 12 months based on the Geriatric Depression Scale (GDS-15), a 15-item questionnaire (range: 0 to 15, higher scores indicate more depressive symptoms, minimal clinical important difference: 2). The multivariable linear regression model was adjusted for levothyroxine starting dose, sex, site, and GDS-15 baseline score.
Results
425 Swiss and Dutch adults with subclinical hypothyroidism were randomised (mean age 75y, 56% female). The mean (SD) TSH was 6.6 (2.1) mU/L at baseline and after 12 months decreased to 3.8 (2.3) mU/L in the levothyroxine group vs 5.9 (2.7) mU/L in the placebo group. At baseline, the mean GDS-15 score was 1.3 (1.9) in the levothyroxine group and 1.0 (1.6) in the placebo group. The mean GDS-15 score at 12 months was 1.4 (2.1) in the levothyroxine and 1.1 (1.7) in the placebo group with an adjusted between-group difference of 0.2 for levothyroxine vs. placebo (95% CI:-0.1 to 0.5; p = 0.29).
Conclusions
In this by far largest RCT on the topic, levothyroxine therapy did not confer a benefit for depressive symptoms. Consequently, our results do not support the practice of prescribing levothyroxine for depressive symptoms when they co-occur with subclinical hypothyroidism.
Key messages
Levothyroxine has no benefit on depressive symptoms in patients with subclinical hypothyroidism. Levothyroxine prescription to patients with subclinical hypothyroidism and depressive symptoms should be reconsidered.
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Affiliation(s)
| | | | - M Feller
- University of Bern, Bern, Switzerland
| | | | - S Mooijaart
- Leiden University Medical Center, Leiden, Netherlands
| | | | - R Du Puy
- Leiden University Medical Center, Leiden, Netherlands
| | - R Peeters
- Erasmus Medical Center, Rotterdam, Netherlands
| | - J Gussekloo
- Leiden University Medical Center, Leiden, Netherlands
| | - N Rodondi
- University of Bern, Bern, Switzerland
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10
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Wildisen L, Moutzouri E, Beglinger S, Syrogiannouli L, Klöppel S, Aujesky D, Rodondi N, Giovane CD, Feller M. Are Patients with Subclinical Hypothyroidism at Risk of Depressive Symptoms? Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Subclinical hypothyroidism (SHypo) may be associated with negative health outcomes including depressive symptoms. However, the evidence is conflicting.
Methods
We conducted a systematic review and individual participant data (IPD) meta-analysis to assess the association between SHypo and depressive symptoms. We requested IPD from cohorts identified through a systematic literature search. The exposure was thyroid function at baseline (SHypo vs. euthyroid; SHypo defined as thyroid stimulating hormone ≥ 4.5 mlU/L, in combination with normal free thyroxine). The outcome was depressive symptoms at first follow-up, measured on any validated scale. We calculated conversion factors to convert all scores into the Beck Depression Inventory (BDI) scale (range: 0-63, higher scores indicate more depression, minimal clinically important difference: 5). We performed a two-stage IPD meta-analysis. In each cohort, we estimated the mean difference (MD) in depressive symptoms scores between those with SHypo and euthyroid controls adjusted for depressive symptoms at baseline. Further, we adjusted the multivariable linear regression analysis for age, sex, education, and income. We pooled the study effect estimates by using a random effects model. Heterogeneity was assessed by I2.
Results
Among six cohorts, we analyzed data from 23,367 participants (65% female, mean age 60.3±13.2 years, SHypo N = 1,463). There was no difference in BDI scores between SHypo (10.6) and controls (10.2) at baseline. After a mean follow-up of 8.2±4.3 years, BDI scores did not differ between SHypo and controls (pooled MD 0.3, 95% CI -0.2 to 0.7, I2 14%). Results remained robust in several sensitivity analyses, and no subgroup at increased risk for depressive symptoms could be identified.
Conclusions
In this IPD meta-analysis, SHypo was not associated with the development of depressive symptoms. Depressive symptoms do not seem to be an indication for levothyroxine therapy in SHypo.
PROSPERO: CRD42018091627
Key messages
Individual studies about the association between subclinical hypothyroidism and depressive symptoms show conflicting results. In this IPD meta-analysis from six prospective cohort studies, patients with subclinical hypothyroidism did not have an increased risk to develop depressive symptoms during a mean follow-up of 8 years.
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Affiliation(s)
- L Wildisen
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - E Moutzouri
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - S Beglinger
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - L Syrogiannouli
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - S Klöppel
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
| | - D Aujesky
- Department of General Internal Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - N Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - C Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - M Feller
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, University of Bern, Bern, Switzerland
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11
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Wildisen L, Moutzouri E, Beglinger S, Syrogiannouli L, Cappola AR, Åsvold BO, Bakker SJL, Ceresini G, Dullaart R, Ferrucci L, Grabe H, Jukema JW, Nauck M, Trompet S, Völzke H, Westendorp RGJ, Gussekloo J, Peeters RP, Klöppel S, Aujesky D, Bauer DC, Rodondi N, Del Giovane C, Feller M. Subclinical thyroid dysfunction and depressive symptoms: protocol for a systematic review and individual participant data meta-analysis of prospective cohort studies. BMJ Open 2019; 9:e029716. [PMID: 31350252 PMCID: PMC6661665 DOI: 10.1136/bmjopen-2019-029716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Prospective cohort studies on the association between subclinical thyroid dysfunction and depressive symptoms have yielded conflicting findings, possibly because of differences in age, sex, thyroid-stimulating hormone cut-off levels or degree of baseline depressive symptoms. Analysis of individual participant data (IPD) may help clarify this association. METHODS AND ANALYSIS We will conduct a systematic review and IPD meta-analysis of prospective studies on the association between subclinical thyroid dysfunction and depressive symptoms. We will identify studies through a systematic search of the literature in the Ovid Medline, Ovid Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases from inception to April 2019 and from the Thyroid Studies Collaboration. We will ask corresponding authors of studies that meet our inclusion criteria to collaborate by providing IPD. Our primary outcome will be depressive symptoms at the first available individual follow-up, measured on a validated scale. We will convert all the scores to the Beck Depression Inventory scale. For each cohort, we will estimate the mean difference of depressive symptoms between participants with subclinical hypothyroidism or hyperthyroidism and control adjusted for depressive symptoms at baseline. Furthermore, we will adjust our multivariable linear regression analyses for age, sex, education and income. We will pool the effect estimates of all studies in a random-effects meta-analysis. Heterogeneity will be assessed by I2. Our secondary outcomes will be depressive symptoms at a specific follow-up time, at the last available individual follow-up and incidence of depression at the first, last and at a specific follow-up time. For the binary outcome of incident depression, we will use a logistic regression model. ETHICS AND DISSEMINATION Formal ethical approval is not required as primary data will not be collected. Our findings will have considerable implications for patient care. We will seek to publish this systematic review and IPD meta-analysis in a high-impact clinical journal. PROSPERO REGISTRATION NUMBER CRD42018091627.
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Affiliation(s)
- Lea Wildisen
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Elisavet Moutzouri
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Shanthi Beglinger
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Anne R Cappola
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania, USA
| | - Bjørn O Åsvold
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stephan J L Bakker
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Graziano Ceresini
- Department of Clinical and Experimental Medicine, Geriatric Endocrine Unit, University Hospital of Parma, Parma, Italy
| | - Robin Dullaart
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, Harbor Hospital, Baltimore, National Institute on Aging NIA-ASTRA Unit, Baltimore, Maryland, USA
| | - Hans Grabe
- Institute for Community Medicine, Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK, German Centre for Cardiovascular Research, Partner Site Greifswald, University Medicine, Greifswald, Germany
| | - Stella Trompet
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Henry Völzke
- Institute for Community Medicine, Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany
| | - Rudi G J Westendorp
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Jacobijn Gussekloo
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Robin P Peeters
- Department of Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stefan Klöppel
- University Hospital of Old Age Psychatry, University of Bern, Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Douglas C Bauer
- Departments of Medicine and Epidemiology & Biostatistics, University of California, San Francisco, California, USA
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Martin Feller
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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