Navigating Thyroid Hormone Deprescribing in Older Adults

April 6, 2026JAMA

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Key Points

To provide evidence-based guidance and clinical frameworks for safely discontinuing or reducing thyroid hormone replacement therapy in older adults.
Synthesizes clinical evidence and consensus guidelines regarding indications for thyroid hormone replacement and the risks of overtreatment in geriatric populations.
Defines patient selection criteria and structured monitoring protocols for gradual medication tapering.
Identifies that a substantial proportion of older adults receiving levothyroxine lack clear lifelong indications, particularly those originally treated for mild subclinical hypothyroidism.
Highlights that chronic thyroid hormone excess in older populations significantly elevates the risks of atrial fibrillation, osteoporotic fractures, and cardiovascular morbidity.
Recommends step-wise dosage reductions paired with thyroid-stimulating hormone surveillance every six to eight weeks to ensure stable euthyroidism.

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Clinical review outlines strategies for deprescribing thyroid hormone in older adults, highlighting safe tapering methods to prevent overtreatment.

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Papaleontiou et al. (2026) studied this question.

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