Approach to the Patient Considering Thyroid Hormone Deprescribing

There is widespread and increasing thyroid hormone overuse. Levothyroxine, a synthetic form of thyroid hormone, is one of the most prescribed medications in the United States. Many patients are started on levothyroxine for the treatment of mild subclinical hypothyroidism or nonevidence-based indications (eg, euthyroid individuals with weight gain or depression). High-certainty evidence does not show a benefit of thyroid hormone initiation in important patient outcomes (eg, quality of life, hypothyroid symptoms) for patients with subclinical hypothyroidism. Moreover, thyroid hormone treatment is associated with potential patient burden, harms, and costs. Yet, once levothyroxine is initiated, it is continued lifelong for most patients. Therefore, active interventions are needed to reduce unnecessary thyroid hormone treatment when it is clinically appropriate. Deprescribing is a structured and evidence-based approach to safely taper or discontinue unnecessary or potentially inappropriate medications, aiming to reduce polypharmacy, improve outcomes, and decrease health care costs and patient harm. Recent limited data support the feasibility and safety of thyroid hormone deprescribing in selected patients and describe clinician-, patient-, and system-level barriers and facilitators to implementing this intervention. We present 3 illustrative clinical cases of patients taking levothyroxine to exemplify the rationale and key considerations in thyroid hormone deprescribing, emphasizing that a structured, patient-centered, and closely supervised plan is essential for safe and effective thyroid hormone deescalation in clinically appropriate situations.