Levothyroxine dose following thyroidectomy is affected by more than just body weight
Abstract
Objectives/Hypothesis: To determine the factors that affect levothyroxine (LT4) requirements following thyroidectomy. Study Design: Retrospective study. Methods: This study evaluated 246 participants who had undergone total thyroidectomy and were on a stable dose of LT4. Actual weight–based (AWB) and ideal body weight–based (IBWB) LT4 dose requirements were analyzed, and other confounders including adherence, concurrent medications, comorbidities, female menopausal status, and hormone replacement therapy were examined. Results: A total of 205 women and 41 men were evaluated, with 48 (20%) benign and 198 (80%) malignant pathology findings. The mean AWB LT4 doses for men and premenopausal women were similar among members of the benign groups and similar among members of the malignant groups. There was a trend for lower dose LT4 in postmenopausal women off hormonal therapy (PM/NH) and on hormonal therapy (PM/H) in the benign group (1.4 and 1.6 μg/kg vs. 1.8 μg/kg in the men and premenopausal women) and a trend for lower dose LT4 in the PM/H women in the malignant group (1.9 μg/kgvs. 2.1 and 2.2 μg/kg in the men and premenopausal women), but they were not significant. However, PM/NH women required significantly less LT4 (1.7 μg/kg) than both the men (2.2 μg/kg) and premenopausal women (2.1 μg/kg) in the malignant group (P=.0006). The IBWB LT4 dosage was not statistically different between groups. Conclusions: LT4 dosage following thyroidectomy, calculated using actual body weight, can range from 1.4 to 2.2 μg/kg and is dependent on diagnosis (benign vs. malignant), goal TSH, sex, and menopausal status. Laryngoscope, 2012
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Studies examining the effect of sex, menopausal status, and the DIO2 Thr92Ala polymorphism on LT4 dose requirement have produced inconsistent findings.
“In contrast to consistency of the findings reported in the above studies, studies examining the effect of sex (214,215, 221), menopausal status (214,215,221), and the presence of the type 2 deiodinase gene ( DIO2 ) Thr92Ala polymorphism (222,224) have produced inconsistent findings.”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [221]
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- Authors
- Baehr, K. M., Lyden, E., Treude, K., Erickson, J., & Goldner, W.
- Affiliations
- University of Nebraska Medical Center (US)
- Nebraska Medical Center (US)
- Corresponding author
- Goldner, Whitney
- Venue
- The Laryngoscope
- Publisher
- Wiley
- Published
- 2012-02-28
- Volume
- 122
- Issue
- 4
- Pages
- 834-838
- ISSN
- 0023-852X (ISSN-L)
- 1531-4995
- OpenAlex
- W1966289128
- Cited by
- 36
- References
- 20
- Citations by year
- 2025: 5 · 2024: 2 · 2023: 2 · 2022: 1 · 2021: 2 · 2019: 9 · 2018: 1 · 2016: 3 · 2015: 5 · 2014: 4 · 2013: 2
- FWCI
- 2.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Laryngoscope (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 › Thyroid Cancer Diagnosis and Treatment
- Keywords
- levothyroxine, thyroidectomy, thyroid hormone replacement, dose requirement, actual body weight, ideal body weight, postmenopausal women, hormone replacement therapy, sex differences
- MeSH terms
- Adult, Body Weight, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Humans, Male, Middle Aged, Retrospective Studies, Thyroid Neoplasms, Thyroidectomy, Thyroxine, Treatment Outcome, Hormone Replacement Therapy
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