Levothyroxine Deprescribing May Be Safe for Some Older Adults: Study

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  Published in Food and Wine on Tuesday, April 7th 2026 at 7:55 GMT by Medscape
      Locale: UNITED STATES

BALTIMORE, MD - April 7, 2026 - A new study published in JAMA Network Open is fueling a growing conversation among healthcare professionals regarding the potential for "deprescribing" levothyroxine, a synthetic thyroid hormone, in carefully selected older adults. The research indicates that discontinuing levothyroxine therapy may be safe for a significant number of individuals aged 67 and over who have well-managed hypothyroidism, suggesting a path towards reducing unnecessary medication burdens and healthcare costs.

The increasing emphasis on geriatric care and the principles of appropriate prescribing have prompted a closer look at long-term medication use, particularly among the elderly. Polypharmacy - the use of multiple medications - is common in older adults, and while often necessary, it can increase the risk of adverse drug interactions, side effects, and falls. This latest study adds weight to the argument that regularly reassessing medication regimens is crucial.

The retrospective cohort study, led by Dr. Ann Goldberg of MedStar Union Memorial Hospital, analyzed data from a substantial group of 27,776 Medicare beneficiaries. Participants had been consistently taking levothyroxine for at least one year and demonstrated stable thyroid-stimulating hormone (TSH) levels for a minimum of six months. Crucially, the study population excluded individuals with pre-existing cardiovascular disease, a history of cancer, or those who had undergone thyroid surgery - conditions where continued levothyroxine use is often essential. Researchers then compared outcomes between those who discontinued levothyroxine (6,875 patients or 24.7% of the cohort) and those who continued treatment, focusing on rates of hospitalization and all-cause mortality.

The findings are remarkably encouraging. The study demonstrated that patients who stopped taking levothyroxine experienced rates of adverse events statistically comparable to those who remained on the medication. Specifically, the adjusted hazard ratio for hospitalization for any reason was 0.92 (95% CI, 0.85-1.00), and the hazard ratio for all-cause mortality was 0.98 (95% CI, 0.91-1.06). These results suggest that, for a specific subset of older adults, the benefits of continued levothyroxine therapy may be outweighed by the potential risks and inconveniences associated with long-term medication use.

"These findings suggest that for many older adults with stable, well-controlled hypothyroidism, levothyroxine may not be necessary," Dr. Goldberg explained. "This could potentially reduce the medication burden and costs for these patients, and minimize the risk of adverse effects associated with levothyroxine." While the study does not advocate for a blanket discontinuation of the drug, it highlights the possibility that many individuals are maintained on levothyroxine unnecessarily, potentially for years after their thyroid function has naturally stabilized.

However, Dr. Goldberg emphasizes the importance of individualized patient assessment. "Patients with cardiovascular disease, cancer, or a history of thyroid surgery should not discontinue levothyroxine without consulting with their healthcare provider," she cautioned. These conditions often require continued thyroid hormone replacement to maintain optimal health and prevent complications.

The study possesses several strengths, including its large sample size and its use of real-world data from Medicare beneficiaries, providing insights into clinical practice outside of controlled trial settings. The researchers also carefully controlled for potential confounding factors that could influence the results. However, the retrospective nature of the study limits the ability to establish a definitive cause-and-effect relationship. Furthermore, data on patient comorbidities and medication adherence were not always complete, and the findings may not be generalizable to populations outside of Medicare beneficiaries.

The findings align with an increasing body of evidence suggesting levothyroxine overuse in the elderly. Previous research has pointed to the frequent prescribing of the medication even in cases of subclinical hypothyroidism, where the benefits of treatment are uncertain. The current study reinforces the need for regular monitoring of TSH levels and a careful consideration of the risks and benefits of continuing levothyroxine therapy in older adults with stable thyroid function. Further research, including randomized controlled trials, is needed to confirm these findings and develop clear guidelines for deprescribing levothyroxine in this population. The conversation surrounding thyroid disease and cardiovascular risk also remains vital, highlighting the need for personalized approaches to treatment and monitoring.