Estimation of a Physiologic Replacement Dose of Levothyroxine in Elderly Patients With Hypothyroidism
Abstract
We gave graded doses of levothyroxine sodium to 11 elderly hypothyroid subjects (mean age, 66.1 years). The daily levothyroxine sodium dose was initially 75 micrograms or less, and was increased by 25 micrograms every six weeks. Serum total thyroxine, total triiodothyronine, and basal thyrotropin levels were measured at the start of the study and at the end of each six-week dose period. A protirelin (thyrotropin-releasing hormone) test was performed when the thyrotropin level returned to normal. Mean daily levothyroxine sodium doses that normalized serum thyrotropin levels and protirelin test were 110 +/- 8 micrograms and 113 +/- 9 micrograms, respectively. Serial basal thyrotropin determinations during stepwise increments in levothyroxine dose indicated physiologic hormone replacement. As determined in our elderly patients, levothyroxine replacement dose was a third less than that formerly recommended.
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Most studies examining factors affecting LT4 dose were retrospective chart reviews, but some were prospective.
“Most studies examining this issue were retrospective chart reviews (47,212-224), but some studies were prospective (38,225-229).”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [217]
Hypothyroid patients with minimal endogenous thyroid function require LT4 doses of 1.6-1.8 μg/kg actual body weight.
“Based on body weight, hypothyroid patients with minimal endogenous thyroid function require LT4 doses of 1.6-1.8 l g/kg of actual body weight (38,47,212,213,215-217,226,227), although some studies estimate higher doses of 2.0-2.1 l g/kg for some patient groups (212,213,226).”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [217]
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- Authors
- Davis, F. B.
- Corresponding author
- Davis, Faith B.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 1984-09-01
- Volume
- 144
- Issue
- 9
- Pages
- 1752
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2048091764
- Cited by
- 64
- References
- 14
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 1 · 2022: 2 · 2021: 1 · 2019: 1 · 2017: 1 · 2016: 3 · 2014: 2 · 2013: 1 · 2012: 4
- FWCI
- 3.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Keywords
- levothyroxine, hypothyroidism, elderly patients, thyroid-stimulating hormone, thyroxine, triiodothyronine, TRH stimulation test, dose titration, thyroid hormone replacement
- MeSH terms
- Aged, Female, Humans, Hypothyroidism, Male, Middle Aged, Thyroid Hormones, Thyrotropin, Thyrotropin-Releasing Hormone, Thyroxine, Triiodothyronine
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