Levothyroxine treatment for subclinical hypothyroidism and risk of adverse renal outcomes: a population-based cohort study
Bibliographic record
Abstract
BACKGROUND: Subclinical hypothyroidism has been linked to adverse renal outcomes, but it is unknown whether treatment of subclinical hypothyroidism reduces the risk of these adverse outcomes. We sought to assess whether treatment of subclinical hypothyroidism with levothyroxine is associated with a decreased risk of developing adverse renal outcomes. METHODS: We conducted a population-based cohort study using a prevalent new-user design. Using the Clinical Practice Research Datalink in the United Kingdom, we assembled a study cohort of individuals aged 18 years and older with newly diagnosed subclinical hypothyroidism between 1998 and 2018. We matched individuals with subclinical hypothyroidism treated with levothyroxine to nontreated individuals with subclinical hypothyroidism based on age, sex, calendar time, duration of subclinical hypothyroidism, and time-conditional propensity score. We included several confounders, including data on demographics, clinical diagnoses, biochemical measures, lifestyle, and prescriptions, in the time-conditional propensity score estimate. The primary outcome was a composite end point of end-stage renal disease (requiring dialysis) and lowering of the estimated glomerular filtration rate of 50% or greater. RESULTS: We matched 76 697 individuals with subclinical hypothyroidism treated with levothyroxine to 76 697 nontreated individuals. The mean age of the study cohort was 63 years, and 77% of patients were female. During a median follow-up time of 1.6 years (levothyroxine treated: 1.0, interquartile range [IQR] 0.4-2.7, yr; nontreated: 2.5, IQR 0.9-5.7, yr), 2426 adverse renal events occurred among nontreated individuals (incidence rate 8.35, 95% confidence interval [CI] 8.02-8.69, per 1000 person-years), and 1255 adverse renal events occurred among levothyroxine-treated individuals (incidence rate 7.93, 95% CI 7.50-8.39, per 1000 person-years). Treatment with levothyroxine was not associated with the risk of adverse renal outcomes among people with subclinical hypothyroidism (adjusted hazard ratio 0.97, 95% CI 0.90-1.04). INTERPRETATION: In this population-based cohort study, there was no evidence that levothyroxine treatment of subclinical hypothyroidism reduced the risk of adverse renal outcomes. Future studies in different populations and with longer duration of follow-up are needed to confirm these findings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".