SummaryObjective Optimal thyroxine replacement following total thyroidectomy is critical to avoid symptoms of hypothyroidism. The aim of this study was to determine the best formula to determine the initiated replacement dose of levothyroxine immediately following total thyroidectomy. Design Prospective study. All patients were initiated on 100 lg levothyroxine and titrated to within the reference range for TSH and free T4. Correlations to height, weight, age, lean body mass (LBM), body surface area (BSA) and body mass index (BMI) were calculated. Patients One hundred consecutive adult patients underwent total thyroidectomy for non-malignant disease. Measurements Comparison between three methods of levothyroxine dose prediction, aiming for a levothyroxine dose correct to within 25 lg of actual dose required. Results Correlations were seen between levothyroxine dose and patient age (r = )0AE346, P < 0AE01), bodyweight (r = 0AE296, P < 0AE01), LBM (r = 0AE312, P < 0AE01), BSA (r = 0AE319, P < 0AE01) and BMI (r = 0AE172, P < 0AE05). A regression equation was calculated (predicted levothyroxine dose = [0AE943 · bodyweight] + [)1AE165 · age] + 125AE8), simplified to (levothyroxine dose = bodyweight ) age + 125) pragmatically. Initiating patients empirically on 100 lg post-operatively showed that 40% of patients achieved target within 25 lg of their required dose; this increased to 59% when using a weight-only dose calculation (1AE6 lg/kg) and to 72% using the simplified regression equation. Conclusions A simple calculated regression equation gives a more accurate prediction of initiated levothyroxine dose following total thyroidectomy, reducing the need for outpatient attendance for dose titration.

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Diode laser is a good tool for several paediatric laryngeal pathologies. The ability to guide the laser light using the flexible glass fibre directly onto the area requiring vapourisation enables very precise treatment.

These two cases highlight the diagnostic and therapeutic role of thyroid surgeons in the management of benign and malignant forms of struma ovarii.