26gaa24 10.3205/26gaa24 urn:nbn:de:0183-26gaa247 Meeting Abstract Überbehandlung bei Levothyroxin-Anwenderinnen und -Anwendern anhand diagnostischer und prognostischer Thyrotropin (TSH)-Grenzwerte: Eine bevölkerungsbasierte Studie Scholle Scholle Oliver H. F. OHF

Leibniz-Institut für Präventionsforschung und Epidemiologie – BIPS, Bremen, GermanyLeibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany

scholle@leibniz-bips.de author Ittermann Ittermann Till T

University Medicine Greifswald, Greifswald, Germany

author Völzke Völzke Henry H

University Medicine Greifswald, Greifswald, Germany

author Pohlabeln Pohlabeln Hermann H

Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany

author Feldkamp Feldkamp Joachim J

Bielefeld University, Bielefeld, Germany

author Günther Günther Kathrin K

Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany

author Friedrich Friedrich Nele N

University Medicine Greifswald, Greifswald, Germany

author Nauck Nauck Matthias M

University Medicine Greifswald, Greifswald, Germany

author Krist Krist Lilian L

Charité - Universitätsmedizin Berlin, Berlin, Germany

author Leitzmann Leitzmann Michael F. MF

University of Regensburg, Regensburg, Germany

author Li Li Yong Y

University of Freiburg, Freiburg, Germany

author Lieb Lieb Wolfgang W

Kiel University, Kiel, Germany

author Mikolajczyk Mikolajczyk Rafael R

Martin Luther University Halle-Wittenberg, Halle (Saale), Germany

author Moreno Velásquez Moreno Velásquez Ilias I

Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany

author Obi Obi Nadia N

University Medical Center Hamburg-Eppendorf, Hamburg, Germany

author Pischon Pischon Tobias T

Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany

author Schmidt Schmidt Börge B

University Hospital of Essen, Essen, Germany

author Schultheiss Schultheiss Ulla T. UT

University of Freiburg, Freiburg, Germany

author Stopsack Stopsack Konrad H. KH

Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany

author Brandes Brandes Berit B

Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany

bbrandes@leibniz-bips.de author German Medical Science GMS Publishing House

Düsseldorf

610 20261021 engl This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). M0661 24 Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA) 33. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie Abstracts München 20261129 20261130 26gaa24 TextBackground/Aim: Many levothyroxine users have thyrotropin (thyroid-stimulating hormone, TSH) levels below the diagnostic reference range (“diagnostic” cut-offs), and are therefore considered overtreated. Evidence from predominantly untreated cohorts has led to a definition of TSH cut-offs based on cardiovascular and all-cause mortality risk (“prognostic” cut-offs). It is unclear how often overtreatment according to prognostic cut-offs occurs. We estimated the prevalence of overtreatment among levothyroxine users based on both cut-offs and identified subgroups with a higher prevalence of overtreatment.Methods: In the baseline assessment of the German National Cohort (NAKO), a population-based prospective multi-center cohort study, TSH levels were available from 109,997 participants aged 19–74 years. We used study-specific TSH cut-offs to assess the prevalence of overtreatment among levothyroxine users.Results: Among 13,095 levothyroxine users, 19.3% (95% confidence interval [CI] 18.6–20.0) were overtreated using the diagnostic TSH cut-off (<0.45 mIU/L) and 42.5% (95% CI 41.6–43.3) were overtreated according to the prognostic cut-off (≤0.87 mIU/L). A higher prevalence of levothyroxine overtreatment based on the prognostic TSH cut-off was particularly observed in older age groups (e.g., ≥60 years vs. 20–39 years: adjusted prevalence ratio [aPR] 1.32, 95% CI 1.21–1.44), in users with a long time since first thyroid diagnosis (e.g., ≥10 years vs. ≤1 year: aPR 1.88, 95% CI 1.39–2.54), and in those with higher levothyroxine doses (e.g., >1–1.5 µg/kg/day: aPR 1.58, 95% CI 1.47–1.70; >1.5 µg/kg/day: aPR 2.12, 95% CI 1.96–2.29; each compared with ≤0.67 µg/kg/day).Discussion/Conclusion: One in five levothyroxine users was overtreated according to the diagnostic TSH cut-off; this prevalence was twice as high when applying the prognostic TSH cut-off. The identification of subgroups with a higher prevalence of overtreatment in this study may help prioritize patients for potential dose reduction or deprescribing of levothyroxine. 0 0 0 0