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Novel Biomarkers and Skeletal Outcomes Associated With Subclinical Thyroid Dysfunction

Information source: University Hospital Inselspital, Berne
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Thyroid Dysfunction; Bone Density; Osteoporosis; Fractures, Bone

Intervention: Levothyroxine (Drug); Placebo (Drug)

Phase: Phase 4

Status: Recruiting

Sponsored by: University Hospital Inselspital, Berne

Official(s) and/or principal investigator(s):
Nicolas Rodondi, MD MAS, Principal Investigator, Affiliation: Clinic for General Internal Medicine, Bern University Hospital Bern

Overall contact:
Nicolas Rodondi, MD MAS, Phone: + 41 31 632 41 63, Email: nicolas.rodondi@insel.ch

Summary

Thyroid hormone is a key regulatory hormone for a range of physiological systems, including the skeleton. Previous studies have suggested that subclinical thyroid dysfunction (SCTD) may be associated with deleterious skeletal effects. However, controversy persists on the clinical relevance of SCTD as well as on optimal thresholds for treatment. Available data have substantial limitations: 1) limited prospective data are available to assess the associations between SCTD and non-cardiovascular outcomes, such as fractures 2) lack of data from large RCTs to investigate the pathophysiological mechanisms of associations between thyroid hormone and bone loss. The aim of the study is to examine the relationship between subclinical hypothyroidism and thyroid hormone replacement in regard to skeletal fragility, bone mineral density (BMD), bone loss and metabolism, and the risk of fractures in elderly participants. The listed parameters will be assessed by dual energy X ray absorptiometry (DXA) and novel bone imaging techniques at baseline, at 1 year and 2 years of follow-up. The study will be nested in the TRUST trial (clinicaltrials. gov ID: NCT01660126), and will make use of its study infrastructure to determine bone biomarkers from biospecimens at baseline, 1 year and 2 years of follow-up from 120 Swiss participants with persistent subclinical hypothyroidism randomized to either thyroxine or placebo in Bern and Lausanne.

Clinical Details

Official title: Novel Biomarkers and Skeletal Outcomes Associated With Subclinical Thyroid Dysfunction: a Prospective Evaluation and Impact of Treatment

Study design: Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment

Primary outcome: Change in bone mineral density (BMD)

Secondary outcome:

Change in bone biomarkers

bone mineral density (BMD)

Detailed description: Background Thyroid hormone is a key regulatory hormone for other physiological systems, including the skeleton. Previous studies have suggested that SCTD may be associated with deleterious skeletal effects. However, controversy persists on the clinical relevance of SCTD as well as on optimal thresholds for treatment. Available data have substantial limitations: 1) limited prospective data are available to assess the associations between SCTD and non-cardiovascular outcomes, such as fractures 2) lack of data from large RCTs to investigate the pathophysiological mechanisms of associations. Objective To examine, within a large RCT of elderly participants with subclinical hypothyroidism (the TRUST trial), the impact of thyroxine therapy on the association between SCTD and skeletal fragility, bone mineral density (BMD), bone loss and metabolism, and the risk of fractures. Methods The existing trial infrastructure (TRUST thyroid trial-Euresearch FP7,clinicaltrials. gov ID: NCT01660126) will be utilized to collect biospecimens from the 120 Swiss participants with persistent subclinical hypothyroidism randomized to either thyroxine or placebo in Bern and in Lausanne. The assessment is performed by means of dual energy X ray absorptiometry (DXA) and peripheral quantitative computed tomography (pqCT) as a novel bone imaging technique at baseline, 1 year and 2 years of follow-up. In parallel, bone turnover markers in the blood plasma will be measured at baseline, 1 year and 2 years of follow-up.

Eligibility

Minimum age: 65 Years. Maximum age: N/A. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Community-dwelling patients aged >= 65 years with subclinical hypothyroidism

- Written informed consent

Exclusion Criteria

- Subjects currently under levothyroxine or antithyroid drugs (amiodarone, lithium)

- Recent thyroid surgery or radio-iodine (within 12 months)

- Grade IV NYHA heart failure

- Prior clinical diagnosis of dementia

- Recent hospitalization for major illness or elective surgery (within 4 weeks)

- Terminal illness

- Patients with rare hereditary problems of galactose intolerance, the Lapp lactase

deficiency or glucose-galactose malabsorption

- Subjects who are participating in ongoing RCTs of therapeutic interventions

(including CTIMPs)

- Plan to move out of the region in which the trial is being conducted within the next

2 years (proposed minimum follow-up period)

Locations and Contacts

Nicolas Rodondi, MD MAS, Phone: + 41 31 632 41 63, Email: nicolas.rodondi@insel.ch

Clinic for General Internal Medicine, Bern University Hospital Bern, Bern 3010, Switzerland; Recruiting
Nicolas Rodondi, MD MAS, Principal Investigator

Department of General Internal Medicine, Lausanne, Vaud 1011, Switzerland; Recruiting
Nelly Pitteloud, MD, Phone: +41 (0)21 314 06 00, Email: nelly.pitteloud@chuv.ch
Nelly Pitteloud, MD, Principal Investigator

Additional Information

Related publications:

Rodondi N, den Elzen WP, Bauer DC, Cappola AR, Razvi S, Walsh JP, Asvold BO, Iervasi G, Imaizumi M, Collet TH, Bremner A, Maisonneuve P, Sgarbi JA, Khaw KT, Vanderpump MP, Newman AB, Cornuz J, Franklyn JA, Westendorp RG, Vittinghoff E, Gussekloo J; Thyroid Studies Collaboration. Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA. 2010 Sep 22;304(12):1365-74. doi: 10.1001/jama.2010.1361.

Rodondi N, Newman AB, Vittinghoff E, de Rekeneire N, Satterfield S, Harris TB, Bauer DC. Subclinical hypothyroidism and the risk of heart failure, other cardiovascular events, and death. Arch Intern Med. 2005 Nov 28;165(21):2460-6.

Starting date: January 2014
Last updated: July 6, 2015

Page last updated: August 23, 2015

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