More than 25 percent of Older Adults May Discontinue Levothyroxine Under Supervision: JAMA
Netherlands: An open-label prospective study has found that approximately 26% of older adults were able to successfully discontinue levothyroxine under physician supervision while maintaining stable thyrotropin (TSH) and free thyroxine levels over one year. Discontinuation was more likely among patients who were on lower baseline doses of levothyroxine.
The findings highlight the importance of periodically reassessing thyroid hormone therapy in older adults to prevent overtreatment and its associated risks, suggesting that nearly one-quarter of patients may safely wean off medication with appropriate monitoring.
A study published in JAMA by Janneke Ravensberg and colleagues from Leiden University Medical Center, the Netherlands, provides important insights into the necessity of long-term levothyroxine therapy in older adults. Levothyroxine is commonly prescribed for hypothyroidism and is often continued indefinitely, but evidence supporting lifelong use in all patients has remained limited.
To address this, researchers conducted a prospective, single-group study in community-dwelling adults aged 60 years and older who had been on a stable levothyroxine dose (≤150 µg/day) for at least one year, with baseline TSH levels below 10 mIU/L. The study was carried out across 58 general practices in the Netherlands, with participants enrolled between January 2020 and July 2022 and followed up until December 2023.
Participants underwent a structured, stepwise reduction in levothyroxine, with thyroid function assessed at least six weeks after each dose adjustment. The aim was to determine the proportion of individuals who could discontinue therapy while maintaining adequate thyroid function after one year.
Of the 370 participants who initiated the discontinuation protocol, 366 completed the study. The median age was 70 years, and most participants were women. The median baseline dose was 50 µg/day. At one year, 95 participants (25.7%) had successfully discontinued levothyroxine while maintaining TSH levels below 10 mIU/L and normal free thyroxine levels.
The following were the key findings:
- Nearly half of the participants who successfully discontinued levothyroxine achieved TSH levels within a tighter, near-normal range.
- Higher discontinuation success was observed in individuals who were on lower baseline doses of levothyroxine.
- Among participants taking 50 µg/day or less, nearly two-thirds were able to stop treatment without affecting thyroid function.
- Discontinuation of levothyroxine did not negatively impact thyroid-related quality of life.
- Quality of life remained stable over the one-year follow-up period regardless of whether discontinuation was successful.
- The findings indicate that supervised and gradual withdrawal of levothyroxine may not lead to worsening symptoms in appropriately selected patients.
The study highlights the need for clinicians to periodically evaluate the continued necessity of levothyroxine therapy in older adults. The authors suggest that routine reassessment, particularly in those on lower doses, could help avoid unnecessary long-term treatment and reduce the risk of overtreatment-related complications.
Overall, the findings indicate that a substantial proportion of older adults may not require lifelong levothyroxine therapy and could safely discontinue treatment under medical supervision.
Reference:
Ravensberg J, Gussekloo J, Le Cessie S, Dekkers OM, Mooijaart SP, Poortvliet RKE. Discontinuation of Levothyroxine in Adults Aged 60 Years or Older. JAMA. Published online April 06, 2026. doi:10.1001/jama.2026.2864
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