近日，荷兰莱顿大学Rosalinde K. E. Poortvliet团队报道了60岁或以上成年人停用左旋甲状腺素的预后。相关论文于2026年4月6日发表在《美国医学会杂志》上。

许多60岁及以上的成年人服用甲状腺激素左甲状腺素，通常需要终身服药。然而，长期持续治疗是否总是必要尚不明确。

为了确定60岁及以上成年人中能够成功停用左甲状腺素治疗的比例，研究组进行了一项单组前瞻性研究，纳入居住在社区的60岁及以上成年人，这些参与者服用稳定剂量（≤150 µg/天）的左甲状腺素至少1年，且促甲状腺激素（TSH）水平低于10 mIU/L。该研究在荷兰的58个全科诊所进行。参与者于2020年1月至2022年7月期间入组，最终随访于2023年12月12日完成。采用开放标签、方案驱动的逐步减量方案，在每次左甲状腺素剂量减少后至少6周进行甲状腺功能检测。主要结局是在开始停用药物后1年时，成功停用左甲状腺素且TSH水平低于10 mIU/L、游离甲状腺素水平在参考范围内的参与者比例。次要结局包括与成功停药相关的因素（人口学特征、甲状腺功能、剂量）以及甲状腺相关生活质量。

在进入左甲状腺素停用阶段的370名参与者中（中位年龄70岁，范围60-89岁；80%为女性；中位TSH水平2.2 mIU/L，范围0.02-9.69 mIU/L；平均游离甲状腺素水平1.21 [SD 0.18] ng/dL），有366名完成了1年最终随访。在这370名参与者中（基线左甲状腺素中位剂量50 µg/天，范围12.5-150 µg/天），有95名（25.7% [95% CI, 21.5%-30.4%]）成功停用左甲状腺素，且在1年时中位TSH水平为5.03 mIU/L（范围1.56-9.40 mIU/L），平均游离甲状腺素水平为1.01 ng/dL（范围0.80-1.43 ng/dL）。在成功停药的95名参与者中，有46名（48.4% [95% CI, 38.6%-58.3%]）的TSH水平低于4.8 mIU/L。在服用左甲状腺素剂量≤50 µg/天的88名参与者中，有56名（63.6%）成功停药。从基线到1年，甲状腺相关生活质量总体上未显示有临床意义的变化，按成功停药与未成功停药分层分析也是如此。

研究结果表明，在这项开放标签、单组前瞻性研究中，25.7%的60岁及以上成年人在停用左甲状腺素1年后仍维持了足够的甲状腺功能。对于60岁及以上的成年人，特别是服用剂量≤50 µg/天的患者，应考虑评估是否需要继续服用左甲状腺素。

附：英文原文

Title: Discontinuation of Levothyroxine in Adults Aged 60 Years or Older

Author: Janneke Ravensberg, Jacobijn Gussekloo, Saskia Le Cessie, Olaf M. Dekkers, Simon P. Mooijaart, Rosalinde K. E. Poortvliet

Issue&Volume: 2026-04-06

Abstract:

Importance  Many adults aged 60 years or older take the thyroid hormone levothyroxine, which is generally continued for life. However, it is uncertain whether long-term continuation is always necessary.

Objective  To determine the percentage of adults aged 60 years or older who can successfully discontinue levothyroxine treatment.

Design, Setting, and Participants  This single-group, prospective study included community-dwelling adults aged 60 years or older who were taking levothyroxine at a stable dosage (≤150 μg/d) for at least 1 year and had a thyrotropin (TSH) level of less than 10 mIU/L. The study was conducted at 58 general practices in the Netherlands. Participants were enrolled between January 2020 and July 2022 and final follow-up occurred on December 12, 2023.

Interventions  Open-label, protocol-driven, stepwise dose reduction with thyroid function testing performed at least 6 weeks after each reduction in levothyroxine dose.

Main Outcomes and Measures  The primary outcome was the proportion of participants who discontinued levothyroxine and had both a thyrotropin level of less than 10 mIU/L and a free thyroxine level within the reference range at 1 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.

Results  Of the 370 participants who started the levothyroxine discontinuation phase (median age, 70 [range, 60-89] years; 80% female; median thyrotropin level, 2.2 [range, 0.02-9.69] mIU/L; mean free thyroxine level, 1.21 [SD, 0.18] ng/dL), 366 completed final follow-up at 1 year. Of the 370 participants (median levothyroxine dose at baseline, 50 [range, 12.5-150] 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 1 year. Of the 95 participants who successfully discontinued levothyroxine, 46 (48.4% [95% CI, 38.6%-58.3%]) had a thyrotropin level of less than 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. Thyroid-related quality of life showed no clinically relevant changes overall from baseline to 1 year and stratified by successful levothyroxine discontinuation vs unsuccessful discontinuation.

Conclusions and Relevance  In this open-label, single-group prospective study, 25.7% of adults aged 60 years or older discontinued levothyroxine treatment while maintaining adequate thyroid function at 1 year. Evaluation of the need to continue levothyroxine should be considered in adults aged 60 years or older, particularly in those taking a dose of 50 μg/d or lower.

DOI: 10.1001/jama.2026.2864

Source: https://jamanetwork.com/journals/jama/fullarticle/2847282