Optimizing Care for Older Adults Through Thyroid Hormone Deprescribing

NCT ID: NCT06629272

Last Updated: 2025-02-07

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

900 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-12-02

Study Completion Date

2029-04-30

Brief Summary

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The proposed study focuses on testing a novel adapted evidence-based multilevel intervention, Deprescribing Thyroid Hormone In Older Adults (D-THIO), to support thyroid hormone deprescribing (dose de-escalation and/or discontinuation) in older adults with thyroid hormone overtreatment and/or misuse and reduce patient harm. Findings from this study will lay the groundwork for broad implementation of D-THIO and serve as a model for deprescribing inappropriate medications for other endocrine conditions and conditions with biochemical monitoring.

Detailed Description

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The proposed study is the first multi-site trial to evaluate a novel evidence-based adapted multilevel intervention, D-THIO (Deprescribing Thyroid Hormone In Older Adults), consisting of evidence-based pharmaceutical opinion to providers, education brochures to patients and facilitated by clinical champions, to support thyroid hormone deprescribing in older adults. We will conduct a type 1 hybrid effectiveness-implementation trial of D-THIO vs. enhanced usual care (American Thyroid Association \[ATA\] provider abbreviated guidelines, ATA patient brochure) at 3 sites (University of Michigan, Henry Ford, University of California San Francisco) in 150 providers (primary care, endocrinologists, geriatricians, advance practice providers) and 750 of their patients 65 years and older who are overtreated with thyroid hormone. We will randomize 1:1 at the provider level within each site. The aims of the study are: 1) to assess the effectiveness of D-THIO on thyroid hormone deprescribing by providers and on reducing overtreatment and misuse with thyroid hormone via EMR, 2) to assess the effectiveness of D-THIO on provider and patient knowledge and attitudes regarding thyroid hormone deprescribing via surveys, and 3) to identify factors related to the implementation of D-THIO across diverse general care settings via post-trial interviews with key stakeholders.

Conditions

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Hypothyroidism

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

DOUBLE

Participants Caregivers
Because the intervention is educational in nature, blinding is not possible. But, to preserve a certain level of blinding and protect against bias, the study will be presented as a "medication optimization study" and consenting patient participants will be informed that their medication profiles will be transmitted to the research team within the following months and that they will receive a customized brochure at some point during the next year that may contain recommendations for change which they can discuss with their prescribing provider. For providers, blinding will be achieved by presenting the same study timeline. Providers will be aware that they will receive a customized letter with thyroid hormone optimization recommendations and that their patients will receive an intervention at some point during the following year, and remain blinded to group allocation throughout the course of the study.

Study Groups

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D-THIO (Deprescribing Thyroid Hormone In Older Adults)

D-THIO is an innovative adapted multilevel intervention.

Providers in the intervention arm will receive: 1) an introductory letter, and 2) the D-THIO pharmaceutical opinion via EMR-compatible correspondence.

After randomization of their treating providers, patients in the intervention arm will receive a study packet including: 1) introductory letter, and 2) the D-THIO patient brochure (educational EMPOWER brochure).

Group Type EXPERIMENTAL

D-THIO (Deprescribing Thyroid Hormone In Older Adults)

Intervention Type BEHAVIORAL

D-THIO consists of evidence-based pharmaceutical opinion letters to providers advising deprescribing for their patients 65 years and older with thyroid hormone overtreatment/misuse and EMPOWER ("Eliminating Medications through Patient Ownership of End Results") brochures to their patients.

Enhanced usual care

This arm will receive enhanced usual care.

Providers in the control arm will receive: 1) an introductory letter signed by the PI and site-PIs, and 2) the ATA hypothyroidism pocket card via EMR.

Patients in the control arm will receive a study packet including: 1) introductory letter, and 2) the ATA patient brochure.

Group Type ACTIVE_COMPARATOR

Enhanced usual care

Intervention Type BEHAVIORAL

American Thyroid Association \[ATA\] provider guidelines, ATA patient brochure

Interventions

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D-THIO (Deprescribing Thyroid Hormone In Older Adults)

D-THIO consists of evidence-based pharmaceutical opinion letters to providers advising deprescribing for their patients 65 years and older with thyroid hormone overtreatment/misuse and EMPOWER ("Eliminating Medications through Patient Ownership of End Results") brochures to their patients.

Intervention Type BEHAVIORAL

Enhanced usual care

American Thyroid Association \[ATA\] provider guidelines, ATA patient brochure

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

1. age 65 years and older
2. on thyroid hormone therapy and have a serum Thyroid-stimulating hormone (TSH) \<0.5 mIU/L or are on thyroid hormone therapy for an inappropriate indication
3. English speaking
4. without cognitive impairment

Exclusion Criteria

1\) Patients with a diagnosis of thyroid cancer, secondary hypothyroidism, history of total thyroidectomy or hospitalization in the past 3 months will be excluded.

Provider eligibility:

Inclusion: Primary care physicians, endocrinologists, geriatricians, and Advanced Practice Providers (APPs) who practice at University of Michigan, Henry Ford Health System or University of California San Fransico (UCSF) and who prescribe thyroid hormone for eligible patients identified above will be eligible for study participation.

Exclusion: Providers who don't prescribe thyroid hormone.
Minimum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute on Aging (NIA)

NIH

Sponsor Role collaborator

University of Michigan

OTHER

Sponsor Role lead

Responsible Party

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Maria Papaleontiou

Associate Professor of Internal Medicine and Research Associate Professor at the Institute of Gerontology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Maria Papaleontiou

Role: PRINCIPAL_INVESTIGATOR

University of Michigan

Locations

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University of California San Francisco

San Francisco, California, United States

Site Status RECRUITING

University of Michigan

Ann Arbor, Michigan, United States

Site Status RECRUITING

Henry Ford Health System

Detroit, Michigan, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Brittany Gay

Role: CONTACT

734-763-8608

Facility Contacts

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Zoe Cheng

Role: primary

628-977-9851

Brittany Gay

Role: primary

734-763-8608

Araceli Ambers

Role: primary

313-916-3906

Other Identifiers

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1R01AG079833-01A1

Identifier Type: NIH

Identifier Source: secondary_id

View Link

HUM00231965

Identifier Type: -

Identifier Source: org_study_id

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