Dr. Spyridoula Maraka

A VA grant is powering a Central Arkansas Veterans Healthcare researcher’s look into the effects of discontinuing thyroid replacement therapy in patients with subclinical hypothyroidism. It may pave the way to address levothyroxine overuse in the United States.

Dr. Spyridoula Maraka, Little Rock VA’s Health Services Research & Development service, will be recruiting Veterans beginning Feb. 1, 2021, for participation in the 18-month randomized, double-blinded, placebo-controlled study. Her research has been given a more than $163,000 grant award.

“Adults in the U.S., including Veterans, are subject to overdiagnosis and overtreatment of subclinical hypothyroidism, which results in substantial and unnecessary economic and treatment burdens,” said Maraka.

“We expect the research to pave the way for initiatives that result in de-prescribing of levothyroxine and address the national epidemic of the drug’s overuse,” she continued.

The second most prescribed drug in America

Doctors increasingly diagnose subclinical hypothyroidism when they find a mildly elevated level of thyroid stimulating hormone, despite normal thyroid hormone levels. It affects up to 200 in 1,000 adults, 135 of whom will have nonspecific symptoms. They often treat subclinical hypothyroidism with levothyroxine. Levothyroxine has become the second most prescribed drug in the U.S., surpassing opioids.

About 50% of patients older than 65 who take levothyroxine take too much and develop iatrogenic hyperthyroidism. This increases their risk for arrhythmias, angina pectoris, bone loss and fractures. According to the grant application, levothyroxine treated subclinical hypothyroidism is prevalent among Veterans.

“Dr. Maraka is an exceptional researcher. She cares deeply for our Veterans,” said Dr. Richard Owen, director of research. “I’m proud of our research department which is one of the best in VA. Projects like this are essential if we are going to continue to grow and innovate treatment option for Veterans.”


Chris A. Durney is a public affairs officer for the Central Arkansas Veterans Healthcare System.

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Published on Dec. 28, 2020

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One Comment

  1. Edward Fake December 31, 2020 at 3:43 pm

    Dear Dr. Maraka, Currently I am on Synthroid 100 mcg from the Lebanon VAMC for hypothyroidism. I also have ischemic heart disease, parkinsonism, and COPD all secondary to agent orange, although I am only rated for the ischemic heart disease. With the synthroid I am in the low normal range, and I am tired/sleepy much of the time. Possibly due to the thyroid not working correctly, but also possible because other meds I take, metoptobol tartrate, guaifenesin, and atorvastatin calcium all cause drowsiness. My thyroid is only working at low normal with the synthroid, if you reduce it, or take it away, what will you replace it with?

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