Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism- Correspondence.

Thyroid Hormone Therapy for Older Adults with Subclinical HypothyroidismTo the Editor: We would note some limitations in the otherwise informative report by Stott et al. on the Thyroid Hormone Replacement for Untreated Older Adults with Subclinical Hypothyroidism -A Randomized Placebo Controlled Trial (TRUST) (June 29 issue). 1 The results for free thyroxine were reported only as pretreatment levels at baseline; values after treatment would have been helpful in interpreting the data.Also, lipid levels should have been included in the cardiovascular risk assessment, since hypothyroidism is a known cause of potentially reversible hyperlipidemia.2 Patients with hyperlipidemia and subclinical hypothyroidism could well be candidates for a trial of thyroxine supplementation.Furthermore, the association between subclinical hypothyroidism and heart disease remains unclear.3,4 Stott et al. observed an imbalance between the levothyroxine group and the placebo group in the point estimates for cardiovascular deaths and deaths from any cause.This trend, although not statistically significant owing to the small numbers of patients, is nonetheless worrisome.Were the deaths from any cause adjudicated?If so, how many were sudden deaths, and how were those patients represented in the levothyroxine group and the placebo group?Such additional data could be valuable when clinicians are evaluating the potential risks associated with the discretionary supplementation of thyroid hormone in elderly patients with subclinical hypothyroidism.