Evaluating levothyroxine cessation and thyroid status: a city-wide population record analysis

Michael Stedman; Suhani Bahl; Peter Taylor; Lakdasa Premawardhana; Okosieme Buchi; Salman Razvi; Simon Pearce; Colin Dayan; Adrian Heald

doi:10.1530/endoabs.117.OC4.4

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Endocrine Abstracts (2026) 117 OC4.4 | DOI: 10.1530/endoabs.117.OC4.4

SFEBES2026 Oral Communications Thyroid (6 abstracts)

Evaluating levothyroxine cessation and thyroid status: a city-wide population record analysis

Michael Stedman ¹ , Suhani Bahl ² , Peter Taylor ² , Lakdasa Premawardhana ² , Okosieme Buchi ² , Salman Razvi ³ , Simon Pearce ³ , Colin Dayan ² & Adrian Heald ⁴

Author affiliations

¹Res Consortium, Andover, United Kingdom; ²University of Cardiff, Cardiff, United Kingdom; ³University of Newcastle, Newcastle, United Kingdom; ⁴Salford Royal Hospital, Salford, United Kingdom

Introduction: Hypothyroidism is conventionally viewed as a lifelong condition requiring continuous Levothyroxine (LT4) therapy. However, some patients discontinue treatment. Understanding the clinical outcomes of these patients, especially those on low doses, can inform whether lifelong therapy is always necessary for milder disease. This study used the Greater Manchester Care Record (2010–2024) to evaluate this.

Methods: We analysed primary care data for patients with a diagnosis of hypothyroidism or no diagnosis code who started LT4 after 2012. We included only patients on a low-dose regimen (average daily dose <80% of full replacement, calculated by BMI) who remained on therapy for at least three months. Inclusion was conditional on having TSH/FT4 results available before starting/during/after stopping LT4. We compared median serial TSH/FT4 values.

Results: Of 52,676 patients who started LT4 during the study, 12.3% (6,470) stopped medication. We focused on the 1,870 patients who met the 3-month treatment and were clinically monitored (had a post-cessation TFT). Patients who stopped had pre-treatment a slightly lower median TSH (6.4mIU/l) FT4 (11.7pmol/l) than those who continued, TSH (7.3mIU/l) and FT4 (11.0pmol/l), suggesting milder initial dysfunction. Crucially, in the 407 patients with post-cessation TSH and FT4 values, the median TSH after stopping LT4 was 3.1mIUL/l (IQR 2.1–4.3) and FT4 was 13.0 pmol/l (IQR 11.5–15.6). This means post-discontinuation at 3+months, TSH and FT4 remained in the euthyroid range.

Conclusion: A significant subset of patients, primarily those started on LT4 for milder indications (low dose), successfully discontinue treatment and maintain thyroid hormone levels within the therapeutic range. The sustained normalisation of TSH/FT4 post-cessation suggests the initial dysfunction may have been transient. This finding raises important questions about the rationale of lifelong LT4 for the large, increasing population on low doses while supporting the need to evaluate supervised withdrawal trials.