Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement

Jonklaas, Jacqueline; Bianco, Antonio C.; Bauer, Andrew J.; Burman, Kenneth D.; Cappola, Anne R.; Celi, Francesco S.; Cooper, David S.; Kim, Brian W.; Peeters, Robin P.; Rosenthal, Mitchell; Sawka, Anna M.

doi:10.1089/thy.2014.0028

Cited by 1,417 publications

(1,560 citation statements)

References 648 publications

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Section: Discussionmentioning

confidence: 99%

“…However, the quality of evidence in the guidelines prepared by the ATA task force was only moderate (25), because of the differences in the design of the studies, in the characteristics of patients and in the standardization of treatments. Also, a wide range of daily T 4 requirements and very high doses were reported (see (25) for review). Some of these limitations were overcome in our study in that: i) all patients were treated and stabilized before surgery using an individually tailored dose and the compliance of patients was carefully checked; ii) the need for T 4 has been measured for the first time in the very same patient before and after thyroidectomy with identical criteria for T 4 assumption; iii) all patients were treated with a semi-suppressive T 4 dose whose target is a narrow TSH range.…”

Section: Discussionmentioning

confidence: 99%

“…However, it seems not sufficient to explain why some patients may not fully recover despite an appropriate dose of T 4 (8,33). On this ground, some studies analyzed the effects of combined T 3 /T 4 treatment in hypothyroid patients, including those who have undergone thyroidectomy (10,27,28,33,34), but mostly failed to show advantages when compared with L-T 4 therapy alone (10,25,34). In summary, our study provided evidence for the first time and in a consistent human model that, after total thyroidectomy, the therapeutic dose of T 4 must be increased by 1/3 as compared with the pre-surgical one.…”

Section: European Journal Of Endocrinologymentioning

confidence: 99%

See 2 more Smart Citations

Individually-tailored thyroxine requirement in the same patients before and after thyroidectomy: a longitudinal study

Duca

Santaguida

Brusca

et al. 2015

European Journal of Endocrinology

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Objective: Thyroxine (T 4 ) requirement after total thyroidectomy for differentiated thyroid carcinoma (DTC) is a debated issue. As most of the studies in the area have been retrospective and/or performed with heterogeneous therapeutic approaches, we designed our study to determine T 4 requirement in the same patients and treatment settings, before and after total thyroidectomy. Design, patients and methods: This was a longitudinal study including 23 goitrous patients treated with T 4 in an individually tailored fashion. All patients exhibited a stable TSH (median TSHZ0.28 mU/l) at a stable T 4 dose for at least 1 year before surgery (median T 4 doseZ1.50 mg/kg per day). The patients underwent total thyroidectomy based on cancer suspicion or compressive symptoms. Eventually diagnosed as having DTC (pT1b-pT2N0) and following surgical and radiometabolic treatment, they were treated with the same pre-surgical doses of T 4 . Results: Three months after surgery,using the same pre-surgical dose, median TSH increased up to 5.38 mU/l (P!0.0001) and so the T 4 dose had to be increased (median T 4 doseZ1.95 mg/kg per day; C30%; P!0.0001). Once divided by patients' age, we observed that, after thyroidectomy and maintaining the same pre-surgical dose, serum TSH significantly increased both in younger and in older patients (median TSHZ4.57 and 6.11 mU/l respectively). Serum TSH was restored to the pre-surgical level by increasing the dose up to 1.95 and 1.77 mg/kg per day (C25 and C21%) respectively. Conclusions: Following the same treatment regimen, a thyroidectomized patient requires one-third higher therapeutic T 4 dose than before surgery. Despite this increase, the dose of T 4 needed in our patients remains significantly lower than that previously described in athyreotic patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: European Journal Of Endocrinologymentioning

confidence: 99%

See 1 more Smart Citation

Individually-tailored thyroxine requirement in the same patients before and after thyroidectomy: a longitudinal study

Duca

Santaguida

Brusca

et al. 2015

European Journal of Endocrinology

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“…In this regard, patients aged older than 65 years who have a sustained TSH >5 U/L should be carefully assessed and treatment should not be initiated unless the patient displays an array of clinical symptoms, increased TPOAB, and comorbidities such as T2DM and secondary hypercholesterolemia. In the older population, above 85 years old, or in the centenarians a 'wait-and-see' strategy is advisable, taking into account the increased upper limit of the TSH reference interval from 6.45 to 7.55 U/L, the general condition of the patient and the potential coexistence of heart disease (76).…”

Section: Hypothyroidism Treatment In the Elderlymentioning

confidence: 99%

MECHANISMS IN ENDOCRINOLOGY: Aging and anti-aging: a Combo-Endocrinology overview

Diamanti-Kandarakis

Dattilo²,

Macut

et al. 2017

European Journal of Endocrinology

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Aging and its underlying pathophysiological background has always attracted the attention of the scientific society. Defined as the gradual, time-dependent, heterogeneous decline of physiological functions, aging is orchestrated by a plethora of molecular mechanisms, which vividly interact to alter body homeostasis. The ability of an organism to adjust to these alterations, in conjunction with the dynamic effect of various environmental stimuli across lifespan, promotes longevity, frailty or disease. Endocrine function undergoes major changes during aging, as well. Specifically, alterations in hormonal networks and concomitant hormonal deficits/excess, augmented by poor sensitivity of tissues to their action, take place. As hypothalamic-pituitary unit is the central regulator of crucial body functions, these alterations can be translated in significant clinical sequelae that can impair the quality of life and promote frailty and disease. Delineating the hormonal signaling alterations that occur across lifespan and exploring possible remedial interventions could possibly help us improve the quality of life of the elderly and promote longevity.

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“…Many patients receiving thyroid hormone therapy suffer either hormone over-replacement or under-replacement [8][9][10]; indeed, in a study evaluating the prevalence of under-or over-treatment of hypothyroidism in patients over 65 years of age, 41% of those receiving thyroid hormones had low TSH and 16% had elevated TSH. Patients with low weight or diabetes present poorer control, and the risk of cardiovascular or skeletal effects due to over-treatment should be taken into account [11].…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with the Stability of Thyroid-stimulating Hormone Values in Hypothyroidism

Marta¹

2017

Arch Med

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In the treatment of hypothyroidism, thyroid-stimulating hormone (TSH) and thyroid hormones are measured and the levothyroxine dose is adjusted in order to achieve a euthyroid state. The initial dose is calculated according to weight, but other factors can influence the dose required to stabilize TSH.Objective: To estimate the percentage of patients who achieve good control of TSH over a 4-year follow-up period; to assess the factors associated with TSH instability.Design: Retrospective population-based cohort study of patients treated for hypothyroidism in a health region in Catalonia, Spain (2010Spain ( -2014. The data were obtained from the pharmacy drug dispensation register included in the computerized medical records of the regional health system. Setting: Lleida health region (Catalonia, Spain).Participants: All patients who had an initial normal TSH value (0.27-5.0 mU/L) or had received levothyroxine were selected. Main measurements:The variables analyzed were: TSH values during follow-up, estimated time with normal TSH, age, sex, body mass index, and compliance with treatment.Results: Of the 2,630 patients with hypothyroidism, 90.3% were women. Mean age was 59.6 years and the treatment compliance rate 84.9%. Patients taking a medium dose of levothyroxine (75-125 mcg) and older patients had higher TSH stability and maintained normal TSH levels for longer (p<0.05). Conclusions:A fifth of patients with hypothyroidism had inadequate thyroid hormone replacement in the first year. Factors associated with TSH stability were levothyroxine dose in the medium range and older age.

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Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement

Cited by 1,417 publications

References 648 publications

Individually-tailored thyroxine requirement in the same patients before and after thyroidectomy: a longitudinal study

Individually-tailored thyroxine requirement in the same patients before and after thyroidectomy: a longitudinal study

MECHANISMS IN ENDOCRINOLOGY: Aging and anti-aging: a Combo-Endocrinology overview

Factors Associated with the Stability of Thyroid-stimulating Hormone Values in Hypothyroidism

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