Thyroid Hormone Replacement for Subclinical Hypothyroidism (TRUST)
Subclinical hypothyroidism (SCH) is a common condition (818%)among older men and women. Although by definition SCH comprises biochemically mild thyroid hormone deficiency without overt symptoms, it is a possible contributor to multiple problems in older age. Thyroid hormone has effects on numerous physiological systems, including the vascular tree, heart, skeletal muscle and brain. Therefore, thyroxine substitution to overcome thyroid hormone deficiency has the potential to give multisystem benefits to older people with SCH.
Small studies have reported reduced atherosclerosis and improved heart function with thyroxine replacement, but no large clinical trials have been performed. Therefore the available evidence is limited, leading to major variations in guidelines and clinical practice, with uncertainty regarding the indications for screening and treatment. The investigators propose a multicentre randomised placebo controlled trial to assess the impact of thyroxine replacement in 3,000 older adults with persisting SCH(excluding those in whom it is a temporary phenomenon who are unlikely to benefit). The investigators will include older men and women with a wide age range and of varying health status. Outcomes include cardiovascular events, health related quality of life, muscle strength and executive cognitive function over 3 years of follow up. Blood and urine samples will be stored in a biobank, to allow future research on causes of ill health in older people with SCH.
The investigators have the support of patient advocacy groups and a consortium with the wide range of expertise and experience required to conduct large scale multicentre clinical trials. The proposal explores the multisystem and quality of life benefits to older people of a tailored approach to management of SCH.
This clinical trial should definitively clarify whether thyroxine treatment for SCH provides benefits that are relevant for patients. This trial will provide strong evidence with the potential to improve clinical practice, reduce health care costs and promote healthy ageing of older adults.
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Treatment
|Official Title:||Multi-modal Effects of Thyroid Hormone Replacement for Untreated Older Adults With Subclinical Hypothyroidism; a Randomised Placebo-controlled Trial|
- Fatal and non-fatal cardiovascular events [ Time Frame: Up to a maximum of 4 years ] [ Designated as safety issue: No ]This will include fatal and no fatal acute myocardial infarction and stroke; amputations for peripheral vascular disease; revascularisations for atherosclerotic vascular disease, including for acute coronary syndrome; heart failure hospitalisations.
- Thyroid-specific quality of life [ Time Frame: Measured at baseline; 3 months; 12 months and close-out. ] [ Designated as safety issue: No ]Change in symptom burden and thyroid-specific QOL (measured using the Thyroid-specific quality of life Patient Reported Outcome questionnaire - ThyPRO; symptom and fatigue domains only).
- Health-related quality of life [ Time Frame: measured at baseline; 3 month; 12 month and final follow up. ] [ Designated as safety issue: No ]The EuroQol5D
- Handgrip strength [ Time Frame: Measured at baseline; 12 months and final follow up. ] [ Designated as safety issue: No ]Handgrip strength measured using the Jadaar hand dynamometer.
- Executive cognitive function [ Time Frame: Measured at baseline and final follow-up. ] [ Designated as safety issue: No ]Letter Digit Coding Test [LDCT).
- Total mortality [ Time Frame: Up to final follow up (maximum 4 years) ] [ Designated as safety issue: No ]Total mortality
- Basic Activities of Daily Living [ Time Frame: Measured at baseline and final follow-up ] [ Designated as safety issue: No ]Basic Activities of Daily Living (ADL) measured using the 20-point Barthel Index [BI].
- Extended activities of daily living [ Time Frame: Measured at baseline and final follow-up ] [ Designated as safety issue: No ]Extended activities of daily living measured using the older American resources and services [OARS]) questionnaire
- Haemoglobin [ Time Frame: Measured at baseline and 1 year ] [ Designated as safety issue: No ]Change in haemoglobin, measured on a full blood count
|Study Start Date:||February 2013|
|Estimated Study Completion Date:||June 2016|
|Estimated Primary Completion Date:||June 2016 (Final data collection date for primary outcome measure)|
Active Comparator: Levothyroxine
Oral Levothyroxine, starting dose 25 or 50 micrograms increased to a maximum of 150 micrograms once daily.
The intervention will start with Levothyroxine 50 µg daily (reduced to 25 µg in subjects <50Kg body weight or if known coronary heart disease - previous myocardial infarction or symptoms of angina pectoris) versus matching placebo; at 3 months if the serum TSH level is <0.4 mU/L dose will be reduced by 25 µg; TSH >=0.4 and <4.6 mU/L, no change to dose; TSH >=4.6mUL, additional 25 µg. The process will be repeated at 12 months then annually. Mock titration will be performed in the placebo group. The maximum possible dose of Levothyroxine that will be prescribed is 150μg (after 4 increments of 25μg at 3 months, 1, 2 and 3 years; from the starting dose of 50μg).
Other Name: Thyroxine
Placebo Comparator: Placebo
|Contact: David J Stott, MBChB MDfirstname.lastname@example.org|
|Contact: Terence J Quinn, MBChB MDemail@example.com|
|Western Infirmary, NHS Greater Glasgow and Clyde||Recruiting|
|Glasgow, United Kingdom, G11 6NT|
|Contact: David J Stott, MBChB, MD 441412114976 firstname.lastname@example.org|
|Principal Investigator: David J Stott, MBChB|
|Sub-Investigator: Terry J Quinn, MBChB(hons)|
|Principal Investigator:||David J Stott, MBChB MD||University of Glasgow|
|Principal Investigator:||Jacobijn Gussekloo, MD||Leiden University Medical Center|
|Principal Investigator:||Rodondi N, MD||University of Bern|
|Principal Investigator:||Patricia Kearney, MD||University College Cork|
|Principal Investigator:||Rudi JG Westendorp, MD||Leiden Academy of Vitality and Ageing|