Protocol
Thyroid assessment and optimisation
Thyroid optimisation · TSH/T3/T4 panel · Thyroid function testing · Thyroid hormone replacement · Levothyroxine (T4) · Liothyronine (T3)
Two claims must be separated. First, testing and treating genuine thyroid disease is established standard of care with decades of clinical evidence, and thyroid panels are ordinary pathology, not a longevity innovation. Second, the "optimisation" claim, treating euthyroid or subclinically hypothyroid people to feel better or age slower, is not supported. The TRUST randomised, double-blind, placebo-controlled trial (737 adults aged 65+ with persistent subclinical hypothyroidism, NEJM 2017) found no benefit of levothyroxine on hypothyroid symptoms or tiredness scores, and pooled analysis with a second RCT found no cardiovascular benefit. An ancillary TRUST analysis found no effect on depressive symptoms. AACE/ATA guidance explicitly states thyroid hormone should not be used to treat obesity in euthyroid patients, nor for depression. No RCT shows that pushing thyroid hormone within the normal range extends healthspan, improves body composition durably, or reduces mortality. Known harms of over-replacement are real and dose-dependent: Singapore's HSA has issued a safety communication on levothyroxine and fracture risk, and long-term suppressive dosing is associated with reduced bone mineral density and atrial fibrillation risk. IMPORTANT UNVERIFIED CLAIM: I confirmed that clinics in both markets include thyroid markers in longevity panels, but I could not verify from any clinic's own site that they prescribe thyroid hormone for optimisation in euthyroid patients. Treat the treatment side as unverified. Net position: the assessment is legitimate and cheap; the optimisation narrative is a commercial construct that the best available human RCT evidence contradicts.
At a glance
- Evidence
- Clinical
- Singapore (HSA)
- Levothyroxine is HSA-registered and available in Singapore as a prescription-only medicine, for example ELTROXIN tablet 50mcg (registration SIN13252P) and 100mcg (SIN13251P), indicated for hypothyroidism, benign euthyroid goitre and prophylaxis of relapse after goitre surgery, concomitant therapy during anti-thyroid treatment, and TSH suppression in thyroid cancer. HSA has issued a Dear Healthcare Professional letter on switching between Euthyrox formulations and a safety alert on levothyroxine and potential fracture risk, with package inserts strengthened on bone resorption and reduced bone mineral density. Liothyronine (T3) is not available through community or retail pharmacies in Singapore and is accessible only via prescription within selected healthcare institutions. Thyroid function blood tests are ordinary clinical pathology and require no HSA product approval. There is no registered indication in Singapore for thyroid hormone "optimisation" in euthyroid people; any such use would be off-label prescribing outside the approved indications.
- Australia (TGA)
- Levothyroxine is TGA-registered and listed on the ARTG under multiple brands (LEVOXINE, THYROX, LEVOTHYROXINE SANDOZ, LEVOTHYROXINE INTAS, among others), indicated for the management of demonstrated thyroid hormone deficiency and for TSH suppression in the management of TSH-responsive thyroid tumours. Liothyronine (T3) products are not registered on the ARTG for general use and are accessed as unapproved therapeutic goods, for example via the TGA Special Access Scheme (intravenous liothyronine such as Thyrotardin or Triostat-R is documented as obtainable through SAS), or through an Authorised Prescriber pathway. Thyroid function blood tests are standard pathology and are not TGA-regulated as therapeutic goods. No TGA-registered indication exists for thyroid hormone use in euthyroid patients for energy, weight or longevity purposes; that use would be off-label and, for T3 specifically, would additionally require an unapproved-goods pathway.
- Offered at
- 3 clinics
Singapore
Health Sciences Authority
- HSA status
- Levothyroxine is HSA-registered and available in Singapore as a prescription-only medicine, for example ELTROXIN tablet 50mcg (registration SIN13252P) and 100mcg (SIN13251P), indicated for hypothyroidism, benign euthyroid goitre and prophylaxis of relapse after goitre surgery, concomitant therapy during anti-thyroid treatment, and TSH suppression in thyroid cancer. HSA has issued a Dear Healthcare Professional letter on switching between Euthyrox formulations and a safety alert on levothyroxine and potential fracture risk, with package inserts strengthened on bone resorption and reduced bone mineral density. Liothyronine (T3) is not available through community or retail pharmacies in Singapore and is accessible only via prescription within selected healthcare institutions. Thyroid function blood tests are ordinary clinical pathology and require no HSA product approval. There is no registered indication in Singapore for thyroid hormone "optimisation" in euthyroid people; any such use would be off-label prescribing outside the approved indications.
- In our SG set
- Tracked in Singapore
- SG clinics
- 1
Australia
Therapeutic Goods Administration
- TGA status
- Levothyroxine is TGA-registered and listed on the ARTG under multiple brands (LEVOXINE, THYROX, LEVOTHYROXINE SANDOZ, LEVOTHYROXINE INTAS, among others), indicated for the management of demonstrated thyroid hormone deficiency and for TSH suppression in the management of TSH-responsive thyroid tumours. Liothyronine (T3) products are not registered on the ARTG for general use and are accessed as unapproved therapeutic goods, for example via the TGA Special Access Scheme (intravenous liothyronine such as Thyrotardin or Triostat-R is documented as obtainable through SAS), or through an Authorised Prescriber pathway. Thyroid function blood tests are standard pathology and are not TGA-regulated as therapeutic goods. No TGA-registered indication exists for thyroid hormone use in euthyroid patients for energy, weight or longevity purposes; that use would be off-label and, for T3 specifically, would additionally require an unapproved-goods pathway.
- In our AU set
- Tracked in Australia
- AU clinics
- 2
Evidence is not approvalAn evidence grade describes how strong the science is. A regulatory status describes whether a body has approved the intervention for an indication. They are different questions, answered separately above.
What it is
Plain-language explainer
A blood panel measuring thyroid-stimulating hormone (TSH) with free T4, often free T3, reverse T3 and anti-TPO antibodies, used to detect overt or subclinical thyroid dysfunction. In mainstream medicine, an abnormal result leads to thyroid hormone replacement, usually levothyroxine (synthetic T4), sometimes with liothyronine (T3). In the longevity setting the panel is bundled into comprehensive hormone screens, and the contested extension is "optimisation": adjusting thyroid hormone in people whose results already sit within the reference range, on the claim that a narrower "optimal" band improves energy, body composition, metabolic rate and healthspan.
Categories
Protocol
Offered by
Where variis has verified this protocol (3)
Keep reading
Related coverage from the newsroom.
Sources
What this profile is built on
- LEVOTHYROXINE SANDOZ (Sandoz Pty Ltd) prescription medicine registration · Therapeutic Goods Administration (TGA)
- LEVOXINE (Sun Pharma ANZ Pty Ltd) prescription medicine registration · Therapeutic Goods Administration (TGA)
- Special Access Scheme and Authorised Prescriber online system · Therapeutic Goods Administration (TGA)
- Liothyronine (Triiodothyronine) newborn use only, ANMF consensus group monograph (notes SAS-only access in Australia) · South Eastern Sydney Local Health District / ANMF
- ELTROXIN TABLET 50MCG [SIN13252P] product information, prescription-only medicine · Singapore National Drug Formulary
- ELTROXIN TABLET 100MCG [SIN13251P] product information · Singapore National Drug Formulary
- Euthyrox (levothyroxine) new formulation tablets: monitoring of patients switching between tablets · Health Sciences Authority (HSA), Singapore
- Levothyroxine and potential risk of fractures, safety alert · Health Sciences Authority (HSA), Singapore
- Liothyronine medication information (not stocked in community pharmacies, institution-restricted) · HealthHub, Singapore
- Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism (TRUST trial) · New England Journal of Medicine / PubMed
- Levothyroxine Treatment and Cardiovascular Outcomes in Older People With Subclinical Hypothyroidism: Pooled Individual Results of Two Randomised Controlled Trials · Frontiers in Endocrinology / PMC
- Effect of Levothyroxine Therapy on the Development of Depressive Symptoms in Older Adults With Subclinical Hypothyroidism · JAMA Network Open
- AACE/ATA Hypothyroidism in Adults guideline summary (thyroid hormones should not be used to treat obesity in euthyroid patients) · Guideline Central / AACE and American Thyroid Association
- Guidelines for the Treatment of Hypothyroidism, ATA Task Force on Thyroid Hormone Replacement · Thyroid (American Thyroid Association)
- Everlab, How It Works (lists thyroid function among assessed domains) · Everlab
- TSH blood test, book thyroid stimulating hormone blood test in Australia · Everlab
- Longevity clinic Sydney, doctor-led preventative medicine (blood and urine testing aligned to cardiometabolic, liver, kidney and thyroid markers) · Executive Medicine
- Thyroid Function Test Singapore · ATA Medical
- Thyroid Function Test Singapore, five thyroid profiles from S$37.06 · Healthscreening.sg (ATA Medical)
- Peptide therapy and longevity in Singapore (describes comprehensive hormone panels including thyroid) · Helix Prive
Every entity profile on variis is sourced. Not medical advice.