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NIHR Signal Thyroid hormone treatment does not help adults with mildly abnormal thyroid tests
There appears to be no benefit from treating adults with subclinical hypothyroidism. Treatment has no effect on quality of life or symptoms compared with placebo or no treatment. Thyroid function tests are commonly performed in general practice for patients who present with a range of symptoms, including fatigue or tiredness. When subclinical hypothyroidism is detected, there is uncertainty whether treatment is worthwhile or how to best monitor success. A recent large study found that hormone l...
NIHR Signal Repeat thyroid function tests for healthy older people are not needed
Older adults with normal thyroid function or subclinical thyroid dysfunction show notable long-term stability of their thyroid hormone levels. This suggests that it is safe for GPs not to routinely retest older adults unless they have risk factors or develop clinical symptoms of overt thyroid dysfunction. Over five years, about 0.2% older adults with normal thyroid function will develop overt hypothyroidism and about 3.5% will develop subclinical hypothyroidism. Amongst those with subclinical h...
NIHR Signal Diabetes drug aids fertility in women with polycystic ovaries
The diabetes drug metformin may help women with polycystic ovarian syndrome who are having problems getting pregnant, but it is unclear whether it works better than an alternative fertility drug that stimulates the ovaries. This study updates a previous review of trials that compare metformin with placebo, no treatment or with the fertility drug clomifene. It summarised results of 48 studies, including 4,451 women. The study found that metformin may work better than placebo or no treatment and ...
NIHR Signal Talking therapy may relieve high levels of anxiety about health conditions
A specific talking therapy called ‘cognitive behavioural therapy for health anxiety’ may help people who are excessively worried about their health. Health anxiety reduced by a small, but meaningful amount, among the medical outpatients who were identified and treated. Delivered in one-hour sessions every two weeks, therapy lasted about four months. It was provided by junior therapists and trained nurses with no previous experience of the therapy. Benefits lasted for about five year...
NIHR Signal Treating subclinical thyroid dysfunction in pregnancy probably has no benefit
Testing for and then treating pregnant women with mild or “subclinical” underactive thyroid did not improve pregnancy outcomes, newborn baby outcomes, or the child’s IQ at three to five years. A clearly underactive thyroid (clinical hypothyroidism) in pregnancy has been linked with various adverse outcomes for the mother and baby, including pre-eclampsia, preterm birth, congenital defects and neurodevelopmental delay. This needs treatment. However, there has been debate around...
NIHR Signal Evidence on best treatment for severe palm sweatiness
For treatment of severe sweaty palms, minimally invasive surgery to cut the sympathetic nerves at a single level, reduces the commonest complications of the procedure. This review looked at the studies of cuts made at different levels and found that compensatory sweating elsewhere in the body was minimised if the cuts were made at the level of the fourth thoracic vertebra. The success in controlling sweaty palms and patient satisfaction were similar whatever level was cut in these trials. Exces...
NIHR Signal Surgery to remove the thymus gland improves weakness for people with myasthenia gravis
Having a thymectomy (surgery to remove the thymus gland) improves various measures of weakness and reduces the need for other treatment in people with myasthenia gravis. When combined with standard steroid treatment, surgery gives a meaningful, but small, improvement compared with steroids alone. Importantly it also reduced the requirement for steroids or immune suppressing drugs and their side effects. Myasthenia gravis is a rare condition where the body’s own immune system attacks the n...
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