Optimal levothyroxine dose to achieve euthyroidism in patients with primary hypothyroidism: analysis according to etiology: análisis según etiología
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...
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2022
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/35157 |
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I10-R327-article-35157 |
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Universidad Nacional de Córdoba |
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Revista de la Facultad de Ciencias Médicas de Córdoba |
| language |
Español Inglés |
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Artículo revista |
| topic |
doença de Hashimoto |
| spellingShingle |
doença de Hashimoto Ramírez Stieben, Luis Agustín Pustilnik, Estefanía Feldman, Rodolfo Paladini, Luciana Mancinelli, Laura Pellizzón, Noelia Andrea Schwarzstein, Diego Optimal levothyroxine dose to achieve euthyroidism in patients with primary hypothyroidism: analysis according to etiology: análisis según etiología |
| topic_facet |
doença de Hashimoto |
| author |
Ramírez Stieben, Luis Agustín Pustilnik, Estefanía Feldman, Rodolfo Paladini, Luciana Mancinelli, Laura Pellizzón, Noelia Andrea Schwarzstein, Diego |
| author_facet |
Ramírez Stieben, Luis Agustín Pustilnik, Estefanía Feldman, Rodolfo Paladini, Luciana Mancinelli, Laura Pellizzón, Noelia Andrea Schwarzstein, Diego |
| author_sort |
Ramírez Stieben, Luis Agustín |
| title |
Optimal levothyroxine dose to achieve euthyroidism in patients with primary hypothyroidism: analysis according to etiology: análisis según etiología |
| title_short |
Optimal levothyroxine dose to achieve euthyroidism in patients with primary hypothyroidism: analysis according to etiology: análisis según etiología |
| title_full |
Optimal levothyroxine dose to achieve euthyroidism in patients with primary hypothyroidism: analysis according to etiology: análisis según etiología |
| title_fullStr |
Optimal levothyroxine dose to achieve euthyroidism in patients with primary hypothyroidism: analysis according to etiology: análisis según etiología |
| title_full_unstemmed |
Optimal levothyroxine dose to achieve euthyroidism in patients with primary hypothyroidism: analysis according to etiology: análisis según etiología |
| title_sort |
optimal levothyroxine dose to achieve euthyroidism in patients with primary hypothyroidism: analysis according to etiology: análisis según etiología |
| description |
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. |
| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2022 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/35157 |
| work_keys_str_mv |
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2024-09-03T21:03:14Z |
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I10-R327-article-351572023-03-20T16:24:58Z Optimal levothyroxine dose to achieve euthyroidism in patients with primary hypothyroidism: analysis according to etiology: análisis según etiología Dosis óptima de levotiroxina para lograr el eutiroidismo en pacientes con hipotiroidismo primario: análisis según etiología Dose ideal de levotiroxina para atingir o eutireoidismo em pacientes com hipotireoidismo primário: análise de acordo com a etiologia: análisis según etiología Ramírez Stieben, Luis Agustín Pustilnik, Estefanía Feldman, Rodolfo Paladini, Luciana Mancinelli, Laura Pellizzón, Noelia Andrea Schwarzstein, Diego doença de Hashimoto 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. Introducción. La levotiroxina (LT4) se considera el estándar de tratamiento del hipotiroidismo. Las recomendaciones actuales sugieren una dosis de LT4 entre 1,6-1,8 µg/kg/día. El objetivo de este estudio fue evaluar la dosis de LT4 en pacientes adultos con hipotiroidismo primario de diferentes etiologías que alcanzaron el eutiroidismo. Métodos. Estudio transversal a partir de la revisión retrospectiva de historias clínicas de pacientes con hipotiroidismo primario en tratamiento con LT4. Los sujetos se clasificaron según el nivel de TSH en sobretratados (TSH<0,4 µUI/ml), eutiroideos (TSH 0,40-4,20) y subtratados (TSH>4,2) y según la etiología del hipotiroidismo. Se realizó un modelo de regresión logística escalonada para evaluar las variables asociadas con TSH <0,4 µUI/ml. Resultados. Se incluyeron 955 pacientes. El 75,13% tuvo un reemplazo adecuado de LT4. La dosis de LT4 para lograr el eutiroidismo fue mayor en pacientes con antecedentes de terapia con yodo radiactivo (1,92 μg/kg) y cirugía de tiroides (1,52 μg/kg), mientras que la dosis de LT4 para lograr el eutiroidismo en pacientes con tiroiditis de Hashimoto y tiroiditis atrófica fue menor que el reportado en estudios previos (1,25 y 1,08 μg/kg, respectivamente). Las variables que se asociaron con una mayor probabilidad de TSH<0,4 µUI/ml fueron el sexo masculino, tiroiditis de Hashimoto, terapia con yodo radiactivo y cirugía de tiroides. Conclusión principal. La dosis de LT4 necesaria para alcanzar el eutiroidismo en pacientes con hipotiroidismo varía según la etiología, siendo mayor en pacientes con hipotiroidismo por tratamiento con yodo radiactivo y cirugía tiroidea. Los pacientes con hipotiroidismo debido a tiroiditis de Hashimoto y tiroiditis atrófica requieren una dosis más baja que las recomendaciones actuales. Introdução. A levotiroxina (LT4) é considerada o padrão de tratamento para o hipotireoidismo. As recomendações atuais sugerem uma dose de LT4 entre 1,6-1,8 µg/kg/dia. O objetivo deste estudo foi avaliar a dose de LT4 em pacientes adultos com hipotireoidismo primário de diferentes etiologias que atingiram eutireoidismo. Métodos. Estudo transversal baseado na revisão retrospectiva de prontuários médicos de pacientes com hipotireoidismo primário em tratamento com LT4. Os indivíduos foram classificados de acordo com o nível de TSH em supertratado (TSH <0,4 µIU/ml), eutireoidiano (TSH 0,40-4,20) e subtratado (TSH> 4,2) e de acordo com a etiologia do hipotireoidismo. Um modelo de regressão logística escalonada foi realizado para avaliar as variáveis associadas ao TSH <0,4 µIU/ml. Resultados. 955 pacientes foram incluídos. 75,13% tiveram uma substituição de LT4 adequada. A dose de LT4 para atingir o eutireoidismo foi maior em pacientes com história de terapia com iodo radioativo (1,92 μg/kg) e cirurgia da tireoide (1,52 μg/kg), enquanto a dose de LT4 para atingir o eutireoidismo em pacientes com tireoidite de Hashimoto e tireoidite atrófica foi inferior ao relatado em estudos anteriores (1,25 e 1,08 μg/kg, respectivamente). As variáveis que se associaram à maior probabilidade de TSH <0,4 µIU/ml foram sexo masculino, tireoidite de Hashimoto, radioiodo e cirurgia da tireoide. Conclusão principal. A dose de LT4 necessária para atingir o eutireoidismo em pacientes com hipotireoidismo varia de acordo com a etiologia, sendo maior em pacientes com hipotireoidismo devido ao tratamento com iodo radioativo e cirurgia da tireoide. Pacientes com hipotireoidismo devido à tireoidite de Hashimoto e tireoidite atrófica requerem uma dose mais baixa do que as recomendações atuais. Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2022-12-21 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf text/html https://revistas.unc.edu.ar/index.php/med/article/view/35157 10.31053/1853.0605.v79.n4.35157 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 79 No. 4 (2022); 353-357 Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 79 Núm. 4 (2022); 353-357 Revista da Faculdade de Ciências Médicas de Córdoba; v. 79 n. 4 (2022); 353-357 1853-0605 0014-6722 10.31053/1853.0605.v79.n4 spa eng https://revistas.unc.edu.ar/index.php/med/article/view/35157/39826 https://revistas.unc.edu.ar/index.php/med/article/view/35157/39152 Derechos de autor 2022 Universidad Nacional de Córdoba http://creativecommons.org/licenses/by-nc/4.0 |