Optimization of thyroxine replacement therapy after total or near-total thyroidectomy for benign thyroid disease
Abstract
Background: Total or near-total thyroidectomy is increasingly used to treat benign thyroid conditions. Lifelong treatment with thyroxine (T4) is then required, but the optimal dose is difficult to predict. This study investigated factors that might predict the ideal T4 dose, with the aim of reducing delays in achieving normal thyroid function after surgery. Methods: Data on 98 patients who underwent total or near-total thyroidectomy for benign disease were reviewed retrospectively. Patient and operative variables that might predict time to achieve normal thyroid function and optimal T4 replacement dose were examined. These data were then used to formulate an algorithm for T4 dosage, based on patient weight, that was subsequently applied prospectively to a comparable group of 27 patients. Results: The median time to achieve normal thyroid function was 14·5 (range 2–120) weeks before introduction of the algorithm, and was greater in patients needing large changes in T4 dose. In multivariate analysis, the best predictors of optimal T4 dose were bodyweight (r = 0·46, P < 0·001) and age (r = −0·32, P = 0·002). Subsequent use of a weight-related algorithm improved time to achieve normal thyroid function. Conclusion: The T4 replacement dosage after total or near-total thyroidectomy is largely influenced by bodyweight. Use of a weight-related algorithm improves patient care compared with use of standard T4 dose-titration methods.
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LT4 replacement doses tend to decrease with age when they are titrated based on serum TSH.
“LT4 replacement doses tend to decrease with age when they are titrated based on serum TSH (213,215,216,219,220).”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [216]
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 [216]
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 [216]
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- Authors
- Olubowale, O., & Chadwick, D. R.
- Affiliations
- Chesterfield Royal Hospital NHS Foundation Trust (GB)
- Corresponding author
- Chadwick, D R
- ORCID
- Chadwick, D R
- Venue
- Journal of British Surgery
- Publisher
- Oxford University Press (OUP)
- Published
- 2006-01-01
- Volume
- 93
- Issue
- 1
- Pages
- 57-60
- ISSN
- 0007-1323 (ISSN-L)
- 1365-2168
- OpenAlex
- W1968341579
- Cited by
- 52
- References
- 14
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 4 · 2023: 6 · 2022: 2 · 2021: 6 · 2019: 5 · 2018: 1 · 2017: 1 · 2016: 2 · 2015: 4 · 2014: 5 · 2013: 2 · 2012: 1
- FWCI
- 1.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- British journal of surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- thyroxine replacement, total thyroidectomy, near-total thyroidectomy, benign thyroid disease, body weight, age, postoperative hypothyroidism
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Body Weight, Dose-Response Relationship, Drug, Female, Humans, Male, Middle Aged, Retrospective Studies, Thyroid Diseases, Thyroidectomy, Thyrotropin, Thyroxine
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