Deprescribing Levothyroxine in Older Adults
One-quarter of older adults, greater than or equal to 60 years age, taking levothyroxine may be able to successfully discontinue treatment while maintaining adequate thyroid function (normal free thyroxine [T4] and a thyroid-stimulating hormone [TSH] <10 mU/L) at 1 year, according to a study published in JAMA.1 The likelihood of successful discontinuation was significantly higher among those receiving lower doses ( less than or equal to 50 µg). The study evaluated how many adults aged 60 years or older could safely discontinue levothyroxine while maintaining adequate thyroid function. This prospective, single-group study was conducted across 58 general practices in the Netherlands between January 2020 and July 2022. It included community-dwelling adults aged greater than or equal to 60 years who had been receiving a stable levothyroxine dose of less than or equal to 150 µg/day for at least 1 year and had a TSH concentration <10 mIU/L. The participants were followed up to December 2023. Participants underwent an open-label, protocol-driven, stepwise reduction in levothyroxine dosage. Thyroid function was assessed at least 6 weeks after each dose reduction. The primary outcome was successful discontinuation at 1 year, defined as remaining off levothyroxine while maintaining a TSH level <10 mIU/L and a free thyroxine (T4) concentration within the reference range. A total of 370 participants, median age 70 years. entered the discontinuation phase; majority were female (80%) and the median baseline levothyroxine dose was 50 µg/day. Of these, at 1 year, 366 participants completed follow-up. Overall, 95 participants (25.7%) successfully discontinued levothyroxine while maintaining adequate thyroid function. Their median TSH concentration was 5.03 mIU/L at 1 year, while the mean free T4 was 1.01 ng/dL. Nearly half of those (48.4%) who successfully discontinued treatment had a TSH level below 4.8 mIU/L. Of the 88 participants taking less than or equal to 50 µg of levothyroxine daily, nearly 64% were able to successfully stop levothyroxine. Thyroid-related quality of life, a secondary study outcome, did not show clinically relevant changes over the course of the study, regardless of whether levothyroxine discontinuation was successful. Mildly raised TSH levels (approximately 5-6 mIU/L) may reflect physiological variation in older adults (greater than or equal to 65 years), while higher levels (greater than or equal to 7.0 mIU/L) may require closer clinical evaluation because of the likelihood of adverse health outcomes.2 The present study suggests that long-term levothyroxine therapy may not be necessary for all older adults, aged greater than or equal to 60 years, particularly those receiving relatively low doses (less than or equal to 50 µg/d). Discontinuation did not result in clinically relevant changes in thyroid-related quality of life. Hence the need for continued levothyroxine therapy in this population group should be periodically reassessed, rather than assuming that levothyroxine must invariably be continued lifelong in all older adults. Supervised deprescribing of levothyroxine in carefully selected patients may help minimize potentially unnecessary long-term medication use. References 1. Ravensberg J, et al. Discontinuation of levothyroxine in adults aged 60 years or older. JAMA. 2026 Apr 6;335(17):1491-1498. doi: 10.1001/jama.2026.2864.2. Kogai T, et al. Revisiting the TSH range in older adults: associations between subclinical hypothyroidism and geriatric conditions. J Endocr Soc. 2026 Feb 26;10(4):bvag045.
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