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Cited by 34Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryHormonal and reproductive studies

TSH may not be a good marker for adequate thyroid hormone replacement therapy

Alevizaki, Maria, Mantzou, Emily, Cimponeriu, Adriana T., Alevizaki, Calliope C., Koutras, Dimitri A.·2005·Wiener klinische Wochenschrift
DOI 10.1007/s00508-005-0421-0
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Abstract

The objective of this study was to evaluate parameters of thyroid function and indices of peripheral thyroid hormone action (such as SHBG) in patients whose hypothyroidism was considered well controlled under current criteria. Eighty-five patients with T4-treated hypothyroidism, 28 of whom had athyria, were compared with 114 normal individuals with the same TSH levels. T3 levels were significantly lower in hypothyroidism although mean T4 and fT4 levels were significantly higher. Furthermore, mean SHBG levels were significantly lower in hypothyroidism independently of age. The difference remained when stricter criteria for adequate treatment were applied (TSH < 2.5 microgU/ml). Significant negative correlations were found between logTSH and T3. The slopes of the regression lines of T3 to TSH were significantly different in the control group and the hypothyroid group: thus, for the same TSH levels, T3 levels were lower in the hypothyroid group. We conclude that patients with T4-treated hypothyroidism have lower T3 levels, lower T3/T4 ratio and lower SHBG than normal individuals with the same TSH, perhaps indicating relative tissue hypothyroidism in the liver. TSH levels used to monitor substitution, mostly regulated by intracellular T3 in the pituitary, may not be such a good indicator of adequate thyroid hormone action in all tissues. The co-administration of T3 may prove more effective in this respect, provided novel suitable preparations are developed. Until this is accomplished, substitution in hypothyroidism should aim at low normal TSH, to ensure normal T3 levels.

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  • In athyreotic individuals treated with LT4 to achieve a normal serum TSH, serum T3 is either normal or lower than in normal individuals.

    “Moreover, in athyreotic individuals treated with LT4 to achieve a normal serum TSH, the serum FT4 is usually higher and the serum T3 is either normal (38,39) or lower than the values seen in normal individuals (39-43).”

    From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [43]

  • Because of tissue heterogeneity, pituitary TSH secretion may not reflect what happens in other target tissues, and therefore serum TSH alone may not be a good marker for the adequacy of thyroid hormone replacement.

    “Because of tissue heterogeneity, pituitary TSH secretion may not reflect what happens in other target tissues, and therefore serum TSH alone may not be a good marker for the adequacy of thyroid hormone replacement [67,68,70] .”

    From 2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism (2012) · cites this paper as [68]

  • Serum T3 and free T3 concentrations are lower in L-T4-treated patients than in controls (T3 1.60 vs. 1.86 nmol/l, free T3 3.70 vs. 4.47 pmol/l, p < 0.001).

    “These differences may be related to differences in serum T3 and free T3 concentrations, which are lower in L-T4-treated patients than in controls (T3 1.60 vs. 1.86 nmol/l, free T3 3.70 vs. 4.47 pmol/l, p ! 0.001) [67,68] .”

    From 2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism (2012) · cites this paper as [68]

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Authors
Alevizaki, M., Mantzou, E., Cimponeriu, A. T., Alevizaki, C. C., & Koutras, D. A.
Affiliations
  • National and Kapodistrian University of Athens (GR)
  • Evangelismos Hospital (GR)
Corresponding author
Alevizaki, Maria
ORCID
Alevizaki, Maria
Venue
Wiener klinische Wochenschrift
Publisher
Springer Science and Business Media LLC
Published
2005-09
Volume
117
Issue
18
Pages
636-640
ISSN
  • 0043-5325 (ISSN-L)
  • 1613-7671
DOI
10.1007/s00508-005-0421-0
OpenAlex
W77726133
Cited by
34
References
28
Citations by year
2026: 1 · 2025: 2 · 2024: 1 · 2023: 2 · 2022: 2 · 2020: 1 · 2019: 1 · 2018: 2 · 2017: 4 · 2016: 3 · 2015: 2 · 2014: 4 · 2013: 1 · 2012: 4
FWCI
0.41
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Wiener klinische Wochenschrift (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
thyroid-stimulating hormone, hypothyroidism, thyroid hormone replacement, levothyroxine, triiodothyronine, sex hormone-binding globulin, T3/T4 ratio, liver, treatment monitoring
MeSH terms
Female, Greece, Humans, Hyperthyroidism, Male, Middle Aged, Prognosis, Sensitivity and Specificity, Statistics as Topic, Thyrotropin, Thyroxine, Triiodothyronine, Reproducibility of Results, Biomarkers, Treatment Outcome, Outcome Assessment, Health Care, Hormone Replacement Therapy

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