MON-622 Can Calcitonin Replacement Improve Quality of Life in Hypothyroid Patients?

Background: Hypothyroidism is one of the most common endocrine hormone deficiencies and is associated with symptoms of cold intolerance, fatigue and weight gain. Many patients with a history of hypothyroidism continue to report persistent symptoms despite treatment with hormone replacement and normalization of Thyroid Stimulating Hormone (TSH) levels. Saravanan et al., reported that approximately 15% of the population studied reported fatigue or psychological symptoms on L-thyroxine even with normal TSH levels. This can prove challenging for physicians as there are few available options for adjunctive therapy for patients reporting significant symptoms that negatively impact their quality of life. Primary hypothyroidism is a common cause of hypothyroidism and is characterized by thyroid gland dysfunction due to radioactive ablation, surgical removal, or autoimmune Hashimoto’s thyroiditis. This dysfunction also impacts calcitonin production in the parafollicular C cells. Calcitonin treatment for persistent symptoms of hypothyroidism despite euthyroidism on replacement hormone has not been studied. However, the use of calcitonin has shown improvements in QoL in patients with osteoporosis and osteoarthritis (Shohrati et al, 2015; Esenyel et al, 2013). We proposed a pilot study in treating subjects with ongoing psychologic or metabolic symptoms and euthyroidism on thyroid hormone replacement with calcitonin. Methods: Subjects with symptomatic hypothyroidism were recruited for the study. Any patient between the age of 18-89, on levothyroxine treatment with normal TSH levels in the past 3 months qualified. Those who were considering pregnancy or had a history of PPI use, smoking, hypocalcemia, glucocorticoid use, congenital hypothyroidism, pituitary disease or thyroid cancer were excluded. Study participants filled out a Modified City of Hope Quality of Life (QoL) questionnaire that included questions about social concerns, physical health and physical well-being rated on a 10 point scale. Preliminary laboratory evaluation included calcitonin, Parathyroid Hormone panel, Phosphorus, TSH, Free T4 and Total T3. Participants were then instructed to use calcitonin nasal spray 200 International Units (IU) daily for 6 weeks. At the conclusion of the study, subjects were asked to fill out the same questionnaire to assess change in QoL. Results: We have undertaken a study to evaluate the effects of calcitonin treatment on subjects with hypothyroidism and suboptimal QoL despite thyroid hormone replacement and normal TSH.