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    Effects of treatment with metformin on TSH levels: a meta-analysis of literature studies.

    Abstract

    CONTEXT

    Some data suggest that metformin affects the thyroid profile in patients with type 2 diabetes, but contrasting results are reported in different settings.

    OBJECTIVE

    The aim of this meta-analysis was to assess the effect of metformin treatment on TSH in subjects with or without thyroid dysfunction.

    DATA SOURCES

    We performed a systematic search of articles evaluating changes in TSH levels in patients receiving metformin.

    STUDY SELECTION

    Studies evaluating TSH levels before and after metformin treatment were included.

    DATA EXTRACTION

    Clinical data, demographic variables, and TSH levels before and after treatment with metformin were extracted. Data were analyzed according to the underlying thyroid disease.

    DATA SYNTHESIS

    A total of 7 datasets (206 patients) were included in the final analysis. After metformin treatment, a slight but significant reduction in TSH levels was found in 4 datasets on 119 patients with overt hypothyroidism receiving l-T4 replacement (mean difference, 1.08; 95% confidence interval [CI], 0.50, 1.65; P=.0003). Similarly, in 2 datasets reporting on a total of 33 patients with subclinical hypothyroidism not receiving treatment with l-T4, a significant reduction in TSH levels was reported (mean difference, 1.59; 95% CI, 1.32, 1.87; P<.00001) after treatment with metformin. In 1 dataset, including 54 euthyroid patients not receiving l-T4, no changes in TSH levels were reported after treatment with metformin (mean difference, 0.18; 95% CI, -0.20, 0.56; P=.35).

    CONCLUSIONS

    Metformin induces a reduction in TSH levels both in overt and in subclinical hypothyroidism. In contrast, no change in TSH levels is found in euthyroid patients.

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    Authors+Show Affiliations

    Lupoli R
    ,

    Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples Italy.

    Di Minno A
    ,
    Tortora A
    ,
    Ambrosino P
    ,
    Lupoli GA
    ,
    Di Minno MN

    Source

    MeSH

    Hormone Replacement Therapy
    Humans
    Hypoglycemic Agents
    Hypothyroidism
    Metformin
    Thyrotropin
    Thyroxine

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review

    Language

    eng

    PubMed ID

    24203069

    Citation

    TY - JOUR T1 - Effects of treatment with metformin on TSH levels: a meta-analysis of literature studies. AU - Lupoli,Roberta, AU - Di Minno,Alessandro, AU - Tortora,Anna, AU - Ambrosino,Pasquale, AU - Lupoli,Gelsy Arianna, AU - Di Minno,Matteo Nicola Dario, Y1 - 2013/12/20/ PY - 2013/11/9/entrez PY - 2013/11/10/pubmed PY - 2014/3/13/medline SP - E143 EP - 8 JF - The Journal of clinical endocrinology and metabolism JO - J. Clin. Endocrinol. Metab. VL - 99 IS - 1 N2 - CONTEXT: Some data suggest that metformin affects the thyroid profile in patients with type 2 diabetes, but contrasting results are reported in different settings. OBJECTIVE: The aim of this meta-analysis was to assess the effect of metformin treatment on TSH in subjects with or without thyroid dysfunction. DATA SOURCES: We performed a systematic search of articles evaluating changes in TSH levels in patients receiving metformin. STUDY SELECTION: Studies evaluating TSH levels before and after metformin treatment were included. DATA EXTRACTION: Clinical data, demographic variables, and TSH levels before and after treatment with metformin were extracted. Data were analyzed according to the underlying thyroid disease. DATA SYNTHESIS: A total of 7 datasets (206 patients) were included in the final analysis. After metformin treatment, a slight but significant reduction in TSH levels was found in 4 datasets on 119 patients with overt hypothyroidism receiving l-T4 replacement (mean difference, 1.08; 95% confidence interval [CI], 0.50, 1.65; P=.0003). Similarly, in 2 datasets reporting on a total of 33 patients with subclinical hypothyroidism not receiving treatment with l-T4, a significant reduction in TSH levels was reported (mean difference, 1.59; 95% CI, 1.32, 1.87; P<.00001) after treatment with metformin. In 1 dataset, including 54 euthyroid patients not receiving l-T4, no changes in TSH levels were reported after treatment with metformin (mean difference, 0.18; 95% CI, -0.20, 0.56; P=.35). CONCLUSIONS: Metformin induces a reduction in TSH levels both in overt and in subclinical hypothyroidism. In contrast, no change in TSH levels is found in euthyroid patients. SN - 1945-7197 UR - https://www.unboundmedicine.com/medline/citation/24203069/Effects_of_treatment_with_metformin_on_TSH_levels:_a_meta_analysis_of_literature_studies_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2013-2965 ER -