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David S. Cooper - One of the best experts on this subject based on the ideXlab platform.
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Thyroid Hormone Therapy for hypothyroidism
Endocrine, 2019Co-Authors: Bernadette Biondi, David S. CooperAbstract:The purpose of this article will be to review the basics of thyroid Hormone Therapy, including various thyroid Hormone formulations, the institution and monitoring of thyroid Hormone Therapy, adverse effects of overtreatment, the management of patients with persistent symptoms despite normal thyroid function tests, and potential new innovations in thyroid Hormone Therapy. The conclusions support the necessity to personalize thyroid Hormone replacement Therapy in hypothyroid patients.
Joann E. Manson - One of the best experts on this subject based on the ideXlab platform.
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Postmenopausal Hormone Therapy and Quality of Life
2017Co-Authors: Kathryn M. Rexrode, Joann E. MansonAbstract:ESPITE THE COMMON PERCEPTION THAT POSTMENOpausal Hormone Therapy improves quality of life in women, few randomized clinical trials have addressed this issue. Moreover, the high rates of discontinuation of Hormone Therapy in the first few years of use in both observational studies 1,2 and randomized trials 3 cast doubt on this assumption. The study by Hlatky et al 4 in this issue of THE JOURNAL presents important and intriguing data regarding Hormone Therapy and quality of life that were previously lacking. This report is particularly informative because the investigators stratify their results according to the presence or absence of vasomotor flushing symptoms at baseline. Hlatky et al compared the effect of Hormone Therapy vs placebo on quality-of-life parameters among women in the Heart Estrogen/Progestin Replacement Study (HERS) trial, a randomized clinical trial of combined conjugated equine estrogens and medroxyprogesterone acetate among women with pre-existing coronary heart disease. Women who received Hormone Therapy rather than placebo had larger declines in physical function and a trend toward increased symptoms of fatigue, but they experienced an improvement in depressive symptoms. Most women (84.3%) did not have vasomotor flushing symptoms at baseline; among these women there were greater declines in physical function and energy with Hormone Therapy than placebo while no changes were noted for mental health or depressive symptoms. Although baseline quality-of-life parameters were worse among 15.7% of women who reported vasomotor flushing, Hormone Therapy in these women was associated with improvement in mental health and reduction in depressive symptoms without significant effects on physical function or energy level. The fact that Hormone Therapy improves menopausal symptoms, such as hot flashes, quality of life among symptomatic women is not a new or unexpected finding; prior studies have consistently reported benefit for women who experience symptoms. 5 Thus, this report’s primary contribution is that the majority of women without vasomotor symptoms at baseline experienced a decrease in physical function and no improvement in mental health with Hormone Therapy. Although not specifically addressed by the investigators, the greater decline in physical function among women treated with Hormone Therapy compared with placebo may well have been due to the increased rates of cardiovascular events associated with Hormone Therapy, especially during the first year of the HERS trial. 3 Improvement in mental health and depressive symptoms in women who received Hormone Therapy was confined to those with menopausal symptoms at baseline. The study by Hlatky et al provides additional evidence that Hormone Therapy may have an unfavorable benefit/risk ratio among older women who have cardiovascular disease. Among women with established cardiovascular disease, randomized trials do not suggest overall benefit and raise the possibility of harm. The HERS trial 3,6 found no reduction in the risk of coronary events and decreased event-free survival with 4 years of Therapy among women randomly assigned to receive combined estrogen and progesterone. Similarly, in the Estrogen Replacement and Atherosclerosis Trial, 7 angiographic progression of atherosclerosis was not reduced by treatment with either estrogen alone or combined estrogen and progesterone. The Women’s Estrogen for Stroke Trial 8 found no benefit on total stroke incidence and an increased risk of fatal stroke among women with prior ischemic stroke who were assigned to estradiol Therapy. An increase in cardiovascular events with estradiol was also suggested by the Papworth Trial. 9 Additionally, among women with established cardiovascular disease in HERS, the risk of venous thromboembolism was increased nearly 3-fold 10 and the risk of gallbladder disease was increased by 40% 11 among women randomly assigned to receive active Hormone Therapy. Thus, for women with cardiovascular disease, the lack of benefit on quality-of-life outcomes in addition to the increased risks of cardiovascular disease, venous thromboembolism, and gallbladder disease would suggest that the risks outweigh the benefits, especially since there are several other options for preventing osteoporosis. 12
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Update in Hormone Therapy use in menopause.
The Journal of clinical endocrinology and metabolism, 2011Co-Authors: Hugh S. Taylor, Joann E. MansonAbstract:The original report from the Women’s Health Initiative (WHI) changed our understanding of the benefits and risks of Hormone Therapy. Since that time, reanalysis of the WHI and additional data from other studies have further refined these concepts. Here we provide an update on recent advances in the field. Menopausal Hormone Therapy continues to have a clinical role in the management of vasomotor symptoms. However, our understanding of the role of Hormones in cardiovasculardiseaseandbreastcancercontinuestoevolve.Furtheranalysesoftheeffectofageand proximity to menopause at the time of initiation of Therapy, duration of treatment, dose, route of administration, and the persistence of risks and benefits after stopping Hormone Therapy are described. In addition, recent data have emerged suggesting that there may be a link between Hormone Therapy and cancers of the lung and ovary. Finally, we discuss new advances in Hormone Therapy that will likely lead to a more favorable benefit-to-risk ratio, enabling safer effective menopausal symptom relief. (J Clin Endocrinol Metab 96: 255–264, 2011)
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benefits and risks of postmenopausal Hormone Therapy when it is initiated soon after menopause
American Journal of Epidemiology, 2009Co-Authors: Ross L Prentice, Joann E. Manson, Robert Langer, Garnet L Anderson, Mary Pettinger, Rebecca D Jackson, Karen C Johnson, Lewis H Kuller, Dorothy S Lane, Jean WactawskiwendeAbstract:The Women's Health Initiative (WHI) randomized controlled trials—trials of the use of 0.625 mg/day of conjugated equine estrogens (CEE) among 10,739 posthysterectomy women and CEE plus 2.5 mg/day of medroxyprogesterone acetate (MPA) among 16,608 women with an intact uterus—were designed to examine the effects of Hormone Therapy on coronary heart disease (CHD) risk and overall health benefits versus risks. The trial design projected a major reduction in CHD risk, based on observational studies, for both regimens. Recruitment into both trials took place during 1993–1998. The CEE/MPA trial was stopped early in 2002 (1–8), after an average of 5.6 years of follow-up, on the basis of an elevation in breast cancer incidence in conjunction with an unfavorable global index—defined as time to incident CHD, stroke, pulmonary embolism, breast cancer, colorectal cancer, endometrial cancer, or hip fracture or to death from other causes. As a result, the potential use of this regimen for primary disease prevention was much reduced, and interest began to focus on the safety and efficacy of relatively short-term Hormone Therapy among recently postmenopausal women. This focus intensified after the CEE trial was also stopped early in 2004 (9–15), after an average of 7.1 years of follow-up, on the basis of an elevation in stroke in conjunction with a limited likelihood of demonstrating a CHD benefit. The global index in the CEE trial, defined as above but without endometrial cancer, differed little between randomization groups, reflecting a balance of health benefits and risks (9). Among women who were assigned to active Hormone Therapy and reported no prior Hormone Therapy, only 10% in the CEE trial and 17% in the CEE/MPA trial were within 5 years of menopause at randomization. As such, effects of Hormone Therapy could not be estimated with precision for these important subsets. An additional sizeable group of women had used Hormones prior to WHI enrollment and had either stopped Hormone use or chosen to undergo a 3-month washout period prior to randomization. Approximately 84% of these women first initiated Hormone Therapy within 5 years following menopause in both the CEE and CEE/MPA trials. These women contribute information on health effects among women who initiate Hormone Therapy soon after menopause, particularly concerning benefits and risks some years after first use of Hormone Therapy. The WHI observational study, carried out among 93,676 postmenopausal women in the same age range (50–79 years) at enrollment in 1993–1998, is available as an additional source of information on the health effects of these regimens. Women in the observational study were drawn from the same populations as the clinical trial women, and many elements of the protocol were common to the 2 WHI components. These included much baseline questionnaire and interview data, as well as the clinical outcomes ascertained and most aspects of the outcome ascertainment methods (16). Results from joint analyses of clinical trial and observational study data have been reported for cardiovascular disease in relation to CEE/MPA (17) and CEE (18); hazard ratio estimates were in agreement between the clinical trials and the observational study for CHD and venous thromboembolism after allowing for confounding and time since Hormone Therapy initiation, though there was lesser agreement for stroke. Allowance for duration of Hormone Therapy use is essential in such analyses, since Hormone Therapy users in the observational study had often been on the regimen reported at enrollment for several preceding years, and hazard ratios declined with increasing duration of use for both CHD and venous thromboembolism. Similar analyses have been conducted for invasive breast cancer (19, 20). Hazard ratios were higher in the observational study than in the clinical trials for both CEE and CEE/MPA, even after consideration of confounding and duration of use. This residual discrepancy could be explained, however, by higher breast cancer hazard ratios among women who first used Hormone Therapy soon after menopause, as compared with those who initiated Hormone Therapy following a lengthy “gap” time. These analyses, suggesting comparatively unfavorable breast cancer effects among recently postmenopausal women, contrast with corresponding results for CHD (21) and coronary calcification (22) that may suggest more favorable effects among younger, recently postmenopausal women. A “postmenopausal estrogen timing hypothesis,” suggesting that estrogens have favorable effects on CHD in recently postmenopausal women but null or harmful effects among older women, has been debated recently (23, 24), with WHI data being central to both sides of the argument. Of course, evaluation of a broader timing hypothesis involving a range of health effects is needed for decision-making concerning use of Hormone Therapy and is a major focus of this paper. We analyzed the effects of CEE and CEE/MPA (particularly longer-term effects), when initiated soon after menopause, on a range of clinical outcomes, including the global index described above, as well as total invasive cancer incidence and total mortality. The analyses used both WHI clinical trial data and combined WHI clinical trial and observational study data.
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Reassessing Benefits and Risks of Hormone Therapy
American Journal of Lifestyle Medicine, 2008Co-Authors: Margery Gass, Shari S. Bassuk, Joann E. MansonAbstract:Recent randomized clinical trials of postmenopausal Hormone Therapy have informed clinical decision making and provided insights that help identify appropriate candidates for treatment. A decline in the use of Hormone Therapy began precipitously in 2002 with publication of data from the Women's Health Initiative. This review examines the scientific literature surrounding this major change in practice and comments on the equilibrating process now taking place. Notably, the incidence of most of the medical conditions adversely affected by Hormone Therapy increases with age. As a result, recently menopausal women—those most interested in using Hormone Therapy—are at lower absolute risk of adverse events than older women. A critical mass of data now suggests that age and time since menopause may also modify relative risks of selected outcomes with use of Hormone Therapy, but this warrants further study. Duration of Hormone Therapy use also appears to influence risk, with the occurrence of certain outcomes (su...
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postmenopausal Hormone Therapy and stroke role of time since menopause and age at initiation of Hormone Therapy
JAMA Internal Medicine, 2008Co-Authors: Francine Grodstein, Joann E. Manson, Meir J Stampfer, Kathryn M. RexrodeAbstract:Background We evaluated stroke risk associated with Hormone Therapy (HT) in younger women, in recently menopausal women, and in older women. Methods Prospective, observational analyses were performed in postmenopausal participants of the Nurses' Health Study, from 1976 to 2004, with biennial mailed questionnaires. Proportional hazards models were used to calculate multivariable-adjusted relative risks (RRs) and 95% confidence intervals (CIs). Results We found a significantly increased risk of stroke for women currently taking HT (estrogen alone: RR, 1.39; 95% CI, 1.18-1.63; and estrogen with progestin: RR, 1.27; 95% CI, 1.04-1.56), a finding that is nearly identical to that of the Women's Health Initiative. This increased risk was observed for women initiating HT at young ages or near menopause and at older ages or more than 10 years after menopause. Short-term ( P for trend, Conclusions Hormone Therapy is associated with an increased risk of stroke, and this increased risk does not appear to be related to the timing of the initiation of HT. In younger women, with lower stroke risk, the attributable risk of stroke owing to Hormone use is modest and might be minimized by lower doses and shorter treatment duration.
Cosimo Durante - One of the best experts on this subject based on the ideXlab platform.
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Thyroid Hormone Therapy in differentiated thyroid cancer
Endocrine, 2019Co-Authors: Giorgio Grani, Valeria Ramundo, Antonella Verrienti, Marialuisa Sponziello, Cosimo DuranteAbstract:Surgery—with or without postoperative radioiodine—is the standard of care for most patients with differentiated thyroid carcinoma (DTC). Thyroid Hormone replacement Therapy is the mainstay of long-term medical management. Patients treated with total thyroidectomy and some who undergo lobectomy alone require thyroid Hormone Therapy to restore euthyroidism with normal serum thyroid-stimulating Hormone (TSH) levels. Because TSH acts as a growth factor for thyroid follicular cells (including those that are neoplastic), it can potentially affect the onset and/or progression of follicular-cell derived thyroid cancer. For this reason, some patients are placed on thyroid Hormone Therapy at doses that suppress secretion of TSH (suppression Therapy). This mini-review looks at the potential benefits and risks of this practice in patients diagnosed with DTC. Aggressive TSH-suppressive Therapy is of little or no benefit to the vast majority of patients with DTC. Practice guidelines, therefore, recommend a graded algorithm in which the potential benefits of suppression are weighed against the associated cardiovascular and skeletal risks. Large randomized controlled studies are needed to confirm the presumed oncological benefits of TSH-suppression and its causal role in adverse cardiac, skeletal, and quality of life effects and to assess the efficacy of TSH normalization in reversing or reducing these effects.
Elina Hemminki - One of the best experts on this subject based on the ideXlab platform.
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Symptom reporting and quality of life in the Estonian Postmenopausal Hormone Therapy Trial
BMC Women's Health, 2008Co-Authors: Piret Veerus, Krista Fischer, Sirpa-liisa Hovi, Mati Rahu, Helle Karro, Elina HemminkiAbstract:Background The aim of the study was to determine the effect of postmenopausal Hormone Therapy on women's symptom reporting and quality of life in a randomized trial. Methods 1823 women participated in the Estonian Postmenopausal Hormone Therapy (EPHT) Trial between 1999 and 2004. Women were randomized to open-label continuous combined Hormone Therapy or no treatment, or to blind Hormone Therapy or placebo. The average follow-up period was 3.6 years. Prevalence of symptoms and quality of life according to EQ-5D were assessed by annually mailed questionnaires. Results In the Hormone Therapy arms, less women reported hot flushes (OR 0.20; 95% CI: 0.14–0.28), sweating (OR 0.56; 95% CI: 0.44–0.72), and sleeping problems (OR 0.66; 95% CI: 0.52–0.84), but more women reported episodes of vaginal bleeding (OR 19.65; 95% CI: 12.15–31.79). There was no difference between the trial arms in the prevalence of other symptoms over time. Quality of life did not depend on Hormone Therapy use. Conclusion Postmenopausal Hormone Therapy decreased vasomotor symptoms and sleeping problems, but increased episodes of vaginal bleeding, and had no effect on quality of life. Trial registration number ISRCTN35338757
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Postmenopausal Hormone Therapy increases use of health services: Experience from the Estonian Postmenopausal Hormone Therapy Trial [ISRCTN35338757]
American journal of obstetrics and gynecology, 2006Co-Authors: Piret Veerus, Krista Fischer, Sirpa-liisa Hovi, Matti Hakama, Mati Rahu, Elina HemminkiAbstract:Objective This study was undertaken to compare utilization of health services and health care costs in a randomized Hormone Therapy trial. Study design A total of 1823 healthy postmenopausal women aged 50 to 64 years at the time of sampling were allocated to combined continuous Hormone Therapy or placebo or no treatment. The analysis was based on routinely collected electronic data in the Estonian Health Insurance Fund database during a follow-up period from 2 to 5 years. Results In the nonblind subtrial, the number of all health care visits was 10% higher and the number of visits to family practitioners 16% higher per person-year in the Hormone Therapy arm. Per person-year, the number of vaginal sonograms was 14% and the number of electrocardiograms 19% higher in the nonblind Hormone Therapy arm. Outpatient health care costs and drug expenses were higher in the nonblind Hormone Therapy arm. In the blind subtrial, the number of gynecologic operations, vaginal sonograms and total health care costs was higher in the Hormone Therapy arm. Conclusion Hormone Therapy caused additional expenses on health care.
Bernadette Biondi - One of the best experts on this subject based on the ideXlab platform.
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Thyroid Hormone Therapy for hypothyroidism
Endocrine, 2019Co-Authors: Bernadette Biondi, David S. CooperAbstract:The purpose of this article will be to review the basics of thyroid Hormone Therapy, including various thyroid Hormone formulations, the institution and monitoring of thyroid Hormone Therapy, adverse effects of overtreatment, the management of patients with persistent symptoms despite normal thyroid function tests, and potential new innovations in thyroid Hormone Therapy. The conclusions support the necessity to personalize thyroid Hormone replacement Therapy in hypothyroid patients.