Thyroid Hormone Replacement for Central Hypothyroidism: A Randomized Controlled Trial Comparing Two Doses of Thyroxine (T4) with a Combination of T4 and Triiodothyronine

Slawik, Marc; Klawitter, Björn; Meiser, E; Schories, Marcus; Zwermann, Oliver; Borm, Katrin; Peper, Martin; Lubrich, Beate; Hug, Martin; Nauck, Markus; Olschewski, Manfred; Beuschlein, Felix; Reincke, Martín

doi:10.1210/jc.2007-0297

Cited by 106 publications

(59 citation statements)

References 38 publications

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“…In children with documented mild CH and short stature, increasing serum FT 4 from the lower third to near the upper third of the normal reference interval during 6 months significantly increases growth velocity (108 4 to be in the mid-normal or in the upper part of the reference range, which was supported in another study (111). In this study, it was observed that CH patients on empirical T 4 doses (1G0.05 mg/kg per day) had worse outcome in terms of BMI, total-, LDL-, and HDL-cholesterol than patients on a body weight-guided dosing (1.6 mg/kg per day) (111).…”

Section: Central Hypothyroidismmentioning

confidence: 54%

“…In this study, it was observed that CH patients on empirical T 4 doses (1G0.05 mg/kg per day) had worse outcome in terms of BMI, total-, LDL-, and HDL-cholesterol than patients on a body weight-guided dosing (1.6 mg/kg per day) (111). The above dose titration studies, therefore, suggest that FT 4 should be in the upper range of normal, TSH levels should be below 0.1 mIU/l using modern sensitive assays, and the dose of L-T 4 should be targeted at w1.6 mg/kg per day meaning 112 mg per day for a 70 kg person.…”

Section: Central Hypothyroidismmentioning

confidence: 68%

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GH replacement in adults: interactions with other pituitary hormone deficiencies and replacement therapies

Filipsson

Johannsson

2009

European Journal of Endocrinology

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Severe GH deficiency (GHD) in adults has been described as a clinical entity. However, some of the features associated with GHD could be due to unphysiological and inadequate replacement of other pituitary hormone deficiencies. This may be true for glucocorticoid replacement that lacks a biomarker making dose titration and monitoring difficult. Moreover, oral estrogen replacement therapy decreases IGF1 levels compared with the transdermal route, which attenuates the responsiveness to GH replacement therapy in women. In addition, in untreated female hypogonadism, oral estrogen may augment the features associated with GHD in adult women. Important interactions between the hormones used for replacing pituitary hormone deficiency occur. Introducing GH replacement may unmask both an incipient adrenal insufficiency and central hypothyroidism. Therefore, awareness and proper monitoring of these hormonal interactions are important in order to reach an optimal replacement therapy. This review will focus on the complex hormonal interactions between GH and other pituitary hormones in GHD and in GH replacement. European Journal of Endocrinology 161 S85-S95

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Section: Central Hypothyroidismmentioning

confidence: 54%

Section: Central Hypothyroidismmentioning

confidence: 68%

GH replacement in adults: interactions with other pituitary hormone deficiencies and replacement therapies

Filipsson

Johannsson

2009

European Journal of Endocrinology

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“…impaired quality of life (QOL) (1,2,3). Generally, serum thyroid-stimulating hormone (TSH) level is used as a marker for dose adjustment of L-T 4 replacement therapy (4,5,6).…”

mentioning

confidence: 99%

Median-lower normal levels of serum thyroxine are associated with low triiodothyronine levels and body temperature in patients with central hypothyroidism

Hirata

Fukuoka

Iguchi

et al. 2015

European Journal of Endocrinology

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Objective: Although it has been recommended that serum free thyroxine (FT 4 ) levels should be targeted to middle-upper normal levels during levothyroxine (L-T 4 ) replacement therapy in patients with central hypothyroidism (CeH), the rationale has not been clarified. Methods: A retrospective single-center study enrolled 116 patients with hypothyroidism (CeH, nZ32; total thyroidectomy (Tx), nZ22; primary hypothyroidism (PH), nZ33; and control benign thyroid nodule (C), nZ29). The patients had received L-T 4 therapy at the Kobe University Hospital between 2003 and 2013. They were stratified according to serum FT 4 level (R1.10 or !1.10 ng/dl), and body temperature (BT), serum free triiodothyronine (FT 3 ) levels, FT 3 /FT 4 ratio, and lipid profiles were compared. The effect of GH replacement therapy on thyroid function was also analyzed. Results: FT 3 levels and FT 3 /FT 4 ratios were significantly lower in patients with CeH than in patients with PH (P!0.05) or C (P!0.05). In patients with FT 4 !1.10 ng/dl, BT was significantly lower in patients with CeH (PZ0.002) and Tx (PZ0.005) than in patients with PH, whereas no differences were found in patients with FT 4 R1.10 ng/dl. In patients with CeH, FT 3 levels were higher in those with GH replacement therapy (PZ0.018). Conclusion: In CeH, patients with median-lower normal levels of serum FT 4 exhibited lower serum FT 3 levels and lower BT. These results support the target levels of serum FT 4 as middle-upper normal levels during L-T 4 replacement therapy in patients with CeH.

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“…In our patient, once the presence of Central H was confirmed and other entities or critical illness were excluded, and no lesion was found in the MRI and no other hormone was altered, the unusual diagnosis of idiopathic isolated Central H was established, possibly caused by deficient TRH synthesis. 27 Because the optimum thyroxin dose for Central H is still unclear, 28 a dose similar to that given to patients with primary hypothyroidism is recommended (after excluding ACTH deficiency). The main difference in treatment between PH and Central H is that TSH cannot be used to monitor the therapy as it is suppressed to <0.1 mU/L in nearly all patients taking doses of T4 that raise their serum free T4 concentrations to normal.…”

Section: -19mentioning

confidence: 99%

Isolated idiopathic central hypothyroidism in an adult, possibly caused by Thyrotropin Releasing Hormone (TRH) deficiency

Prieto-Tenreiro¹,

Díaz-Guardiola²

2010

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Thyroid Hormone Replacement for Central Hypothyroidism: A Randomized Controlled Trial Comparing Two Doses of Thyroxine (T4) with a Combination of T4 and Triiodothyronine

Abstract: Background: Dosage of T 4 in central hypothyroidism is primarily guided by the free serum T 4 level (fT4). However, the optimum fT4 range is ill defined, and subtle hypothyroidism might be missed using this approach.

Cited by 106 publications

References 38 publications

GH replacement in adults: interactions with other pituitary hormone deficiencies and replacement therapies

GH replacement in adults: interactions with other pituitary hormone deficiencies and replacement therapies

Median-lower normal levels of serum thyroxine are associated with low triiodothyronine levels and body temperature in patients with central hypothyroidism

Isolated idiopathic central hypothyroidism in an adult, possibly caused by Thyrotropin Releasing Hormone (TRH) deficiency

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