Is continuation of levothyroxine treatment in older adults always necessary?

Levothyroxine is the preferred treatment for hypothyroidism and is one of the most commonly prescribed medications worldwide. It is often started in adults aged 50–70 years, and often continued long-term because current guidelines do not address reevaluation for discontinuation. However, it is uncertain whether long-term continuation is always necessary. Many older adults may be receiving unnecessary treatment with levothyroxine, putting them at risk of iatrogenic thyrotoxicosis, which is associated with an increased risk of fractures, atrial fibrillation and cognitive impairment. Researchers in the Netherlands recently performed a study to determine the percentage of adults aged 60 years or older who could successfully discontinue levothyroxine treatment. The single-group, prospective study was conducted at 58 general practices in the Netherlands. It included community-dwelling adults 60 years of age or older who were taking levothyroxine at a stable dosage (≤ 150 μg/d) for at least one year and had a thyrotropin (TSH) level of < 10 mIU/L.The study employed an open-label, protocol-driven, deprescribing of levothyroxine, with stepwise levothyroxine dose reduction, and thyroid function testing performed at least six weeks after each reduction in dose. Dose reduction proceeded only if the thyrotropin level was < 10 mIU/L, the free thyroxine level was greater than or equal to the lower limit of the reference range, and the patient and their general practitioner agreed with the change in dose.The primary outcome was the proportion of participants who discontinued levothyroxine and had both a thyrotropin level of < 10 mIU/L and a free thyroxine level within the reference range at one year after the start of discontinuation. The secondary outcomes included factors associated with successful discontinuation (demographics, thyroid function, dose) and thyroid-related quality of life.Key results:The study included 370 participants who started the levothyroxine discontinuation (deprescribing) phase (median age, 70 years; 80% female; median thyrotropin level, 2.2 mIU/L; mean free thyroxine level, 1.21 ng/dL); 366 completed the final follow-up at one year. Of the 370 participants (median levothyroxine dose at baseline, 50 μg/d), 95 (25.7% [95%CI, 21.5%–30.4%]) successfully stopped taking levothyroxine and had a median thyrotropin level of 5.03 mIU/L (range, 1.56–9.40 mIU/L) and a mean free thyroxine level of 1.01 ng/dL (range, 0.80–1.43 ng/dL) at one year. Of the 95 participants who successfully discontinued levothyroxine, 46 (48.4% [95%CI, 38.6%–58.3%]) had a thyrotropin level of < 4.8 mIU/L. Among the 88 participants taking a levothyroxine dose of 50 μg/d or lower, 56 (63.6%) successfully discontinued this treatment.A higher baseline levothyroxine dose was independently associated with a lower odds for successful discontinuation (odds ratio, 0.95 [95% CI, 0.94–0.96] per 1 μg difference in dose).Thyroid-related quality of life showed no clinically relevant changes overall from baseline to one year and stratified by successful levothyroxine discontinuation vs unsuccessful discontinuation. The results of this open-label, single-group prospective study support reassessment of the need for continuation of levothyroxine therapy in older adults, as 25.7% of adults aged 60 years or older were able to discontinue levothyroxine treatment while maintaining adequate thyroid function at one year. The authors conclude that the need to continue levothyroxine should be evaluated in adults aged 60 years or older, particularly in those taking doses of 50 μg/d or lower.Reference:Ravensberg J, Gussekloo J, Le Cessie S, et al. Discontinuation of levothyroxine in adults aged 60 years or older. JAMA 2026. Published online April 6, 2026. (accessed April 7, 2026).

Is continuation of levothyroxine treatment in older adults always necessary?

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