Primary hypothyroidism in the community

Tan, Ngiap Chuan; Chew, Rong Quan; Koh, Yi Ling Eileen; Subramanian, Reena Chandini; Sankari, Usha; Meyappan, Meykkumar; Cho, Li Wei

doi:10.1097/md.0000000000006145

Cited by 7 publications

(6 citation statements)

References 13 publications

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“… 6 However, when we compare the dose reported in previous studies with that obtained in our population, we confirm that the LT4 requirements to reach the euthyroid state are lower. Recent studies 16 , 17 support our finding and highlight the need for a review of current recommendations for the treatment of patients with hypothyroidism.…”

Section: Discussionsupporting

confidence: 80%

“…Another study demonstrated that overtreated subjects received a higher dose of LT4 than those in the euthyroid state (1.4 μg/kg/day versus 1.1 μg/kg/day). 17 Our initial analysis showed that the variables involved in the patient's overtreated (TSH <0.4 µIU/ml) were higher LT4 dose, male gender, lower BW, and higher frequency of radioiodine therapy, Hashimoto's thyroiditis, and thyroid surgery. Therefore, we performed a logistic regression analysis to evaluate the variables involved with a TSH level <0.4 µIU/ml and we observed that LT4 dose and history of thyroid surgery and Hashimoto's thyroiditis were initially associated with a greater probability of overtreatment.…”

Section: Discussionmentioning

confidence: 93%

“…However, the cause of hypothyroidism does not seem to be the most influential factor since, in the stepwise logistic regression model, only the LT4 dose was associated with a greater probability of overtreatment, which is consistent with previous studies. 17 This finding would allow the stratification of patients who need a closer biochemical follow-up.…”

Section: Discussionmentioning

confidence: 95%

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Optimal levothyroxine dose to achieve euthyroidism in patients with primary hypothyroidism: analysis according to etiology

Stieben

Pustilnik²,

Feldman³

et al. 2022

Rev Fac Cien Med Univ Nac Cordoba

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Introduction. Levothyroxine (LT4) has been considered the standard of care for treatment of hypothyroidism. Current recommendations suggest a LT4 dose between 1.6–1.8 µg/kg/day. The aim of this study was to evaluate the LT4 dose for adult patients with primary hypothyroidism of different etiologies who reached euthyroidism. Methods. A cross-sectional study was performed from the retrospective review of the charts of patients with primary hypothyroidism in treatment with LT4. Subjects were classified according to TSH level in overtreated (TSH < 0.4 µIU/ml), euthyroid (TSH 0.40-4.20), and undertreated (TSH >4.2) and according to the etiology of hypothyroidism. A stepwise logistic regression model was performed to evaluate the variables associated with TSH<0.4 µIU/ml. Results. 955 patients were included. 75.13% of the patients had an adequate LT4 replacement. LT4 dose to achieve euthyroidism was higher in patients with a history of radioiodine therapy (1.92 μg/kg) and thyroid surgery (1.52 μg/kg), while the LT4 dose required to achieve euthyroidism in patients with Hashimoto's thyroiditis and atrophic thyroiditis was lower than that reported in previous studies (1.25 and 1.08 μg/kg, respectively). The variables that were associated with a higher probability of TSH<0.4 µIU/ml were male gender, Hashimoto's thyroiditis, radioiodine therapy, and thyroid surgery. Major conclusion. LT4 dose required to achieve euthyroidism in patients with hypothyroidism varies according to the etiology, being higher in patients with hypothyroidism due to radioiodine therapy and thyroid surgery. Patients with hypothyroidism due to Hashimoto's thyroiditis and atrophic thyroiditis require a lower dose than current recommendations.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 95%

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Optimal levothyroxine dose to achieve euthyroidism in patients with primary hypothyroidism: analysis according to etiology

Stieben

Pustilnik²,

Feldman³

et al. 2022

Rev Fac Cien Med Univ Nac Cordoba

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“…The dosage regimen of levothyroxine depends upon many factors, including body weight and BMI [1]. The demographic and dosing factors influence thyroid status [13]. Our study has predicted the correlation of levothyroxine dosage in primary hypothyroidism in the Pakistani population with patients' anthropometric measures like body weight and BMI.…”

Section: Discussionmentioning

confidence: 74%

Weight and Body Mass Index for Predicting Thyroxine Dose in Primary Hypothyroidism

Raashid¹,

Ishtiaq²,

Kamin³

et al. 2021

Cureus

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BackgroundThe treatment of primary hypothyroidism with thyroxine is weight-based or body mass index (BMI)-based. However, significant variation in the dose and the consequent delay in achieving euthyroid state is observed along the spectrum of patient body weights. ObjectivesTo determine the weight and BMI-based dosing of thyroxine in primary hypothyroidism to achieve euthyroidism. Material and methodsIt was a retrospective review of the patient records conducted in the department of endocrinology, Shifa International Hospital, Islamabad, from July 1, 2014, to June 30, 2019 (five-year period). Patients with clinical and biochemical hypothyroidism were enrolled and initiated on thyroxine replacement to achieve euthyroid status. A total of 504 patients were included in the study. ResultsThe mean age was 44.5 ±13.6 standard deviation. Females were 83.5%. The mean dose of thyroxine to achieve euthyroid status was 107.7 ± 39.3 mean standard deviation mcg/day, i.e. 1.4 (0.5) mcg/kg/day. Euthyroid status was achieved in 264 (52.4%) of patients at three months. The mean TSH level after treatment was 2.09 (1.2) mU/L. The linear regression model showed that BMI and weight are independent predictors of the required thyroxine dose (R and R square values are .274 and 0.075 for BMI and .319 and .102 for weight, respectively (P-value <.0001). There was no impact of age, gender, height, and duration of disease on achieving euthyroid at six months after treatment (P values: .85, .394, .827, and .105, respectively). ConclusionThe optimum dose in primary hyperthyroidism can be determined with body weight and BMI-based calculations.

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“…However, weight-based L-T4 dose determination has been recommended by both the American and European thyroid associations for L-T4 initiation. Race, ethnicity (African Americans versus Caucasians), and obesity (obese versus non-obese) may influence weight-based L-T4 dose determination [1,[5][6][7][8][9][10]. Thyrotropin of less than 2.5 µIU/L was suggested as a more appropriate therapeutic target in hypothyroid patients requiring L-T4 because most healthy subjects have a TSH of less than 2.5 µIU/L [8].…”

mentioning

confidence: 99%

Real-world derived weight-based levothyroxine doses to achieve optimal thyrotropin target in different degrees of autoimmune hypothyroidism

Elsherbiny

2024

Egypt J Intern Med

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Purpose All patients with overt and severe subclinical hypothyroidism (SCH), and some with mild SCH require levothyroxine (L-T4) therapy. The present study aims to report real-world derived weight-based L-T4 doses to achieve optimal–low normal–thyrotropin target in different degrees of autoimmune hypothyroidism. Methods This was a retrospective study of patients with autoimmune hypothyroidism. Inclusion criteria were consistent achievement of optimal TSH target (0.3 to 2.5 µIU/L) using a stable L-T4 dose for at least 6 months. Patients were classified into 4 groups: group 1; mild SCH, group 2; severe SCH, group 3; overt hypothyroidism, and group 4; hypothyroidism with unknown initial TSH and free T4. Weight-based L-T4 doses were calculated for each group. Results Eighty-seven, 95, 75, and 91 patients met the inclusion criteria for groups 1–4, respectively. Weight-based L-T4 dose was the lowest in group 1 (1 ± 0.25 µg/kg/day), was the highest in group 3 (1.4 ± 0.29 µg/kg/day), while in groups 2 (1.2 ± 0.26 µg/kg/day), and 4 (1.2 ± 0.31 µg/kg/day) were not statistically different from each other. There was a significant decrease in weight-based L-T4 dose with increasing body weight categories in groups 1 and 2, and a significant difference between those less than 60 or ≥ 60 years of age in group 3. Conclusion Real-world derived weight-based L-T4 doses to achieve optimal TSH target are 1, 1.2, and 1.4 µg/kg/day for patients with mild, severe SCH, and overt autoimmune hypothyroidism, respectively. Age and body weight subcategories can better fine-tune required doses.

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Primary hypothyroidism in the community

Cited by 7 publications

References 13 publications

Optimal levothyroxine dose to achieve euthyroidism in patients with primary hypothyroidism: analysis according to etiology

Optimal levothyroxine dose to achieve euthyroidism in patients with primary hypothyroidism: analysis according to etiology

Weight and Body Mass Index for Predicting Thyroxine Dose in Primary Hypothyroidism

Real-world derived weight-based levothyroxine doses to achieve optimal thyrotropin target in different degrees of autoimmune hypothyroidism

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