Seeking optimization of LT4 treatment in patients with differentiated thyroid cancer
Open accessAbstract
Abstract Levothyroxine sodium (LT4) is the mainstay treatment to replace thyroid hormonal production in thyroidectomized patients, but, depending on the aggressiveness of the cancer and on the risk of recurrence, patients with differentiated thyroid cancer may also be treated in a TSH-suppressive or semi-suppressive mode. The pathophysiological rationale for this LT4 treatment stems from the role of TSH, considered to be a growth factor for follicular cells, potentially inducing initiation or progression of follicular cell-derived thyroid cancer. Therefore, accurate tailoring of treatment, taking into account both patient characteristics (age and comorbidities) and risk of persistent/recurrent disease, is highly recommended. Furthermore, adjustments to traditional LT4 treatment should be made in thyroidectomized patients due to the lack of thyroidal contribution to whole body triiodothyronine (T3) concentration. Since LT4 exhibits a narrow therapeutic index and the side effects of over- and under-treatment could be deleterious, particularly in this category of patients, caution is required in dose individualization, in the mode of ingestion, and in potential pharmacological and other types of interference as well. Our aim was to analyze the current knowledge concerning LT4 dose requirements in patients with thyroid cancer according to different therapeutic approaches, taking into account a number of factors causing interference with LT4 efficacy. Specific mention is also made about the use of the novel LT4 formulations.
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An increased dose up to 25% may be required in thyroidectomized patients to achieve the desired T4 concentration or the target TSH.
“An increased dose up to 25% may be required in thyroidectomized patients to achieve the desired T4 concentration or the target TSH (105, 106).”
From ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism (2025) · cites this paper as [106]
In “Estimating LT4 requirements in thyroidectomized patients” (page not provided), the paper reports that an approximately 25% higher T4 dose was needed to achieve a TSH value similar to the presurgical value in 23 patients thyroidectomized for differentiated thyroid cancer. The Conclusions (page not provided) also say LT4 need following thyroidectomy may increase by 20–25%. These passages support the dose increase and TSH target, but do not establish the stated purpose of achieving a desired T4 concentration. (LLM, conf=0.84)
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- Authors
- Stramazzo, I., Capriello, S., Antonelli, A., Fallahi, P., Centanni, M., & Virili, C.
- Affiliations
- Sapienza University of Rome (IT)
- University of Pisa (IT)
- Corresponding author
- Centanni, Marco
- ORCID
- Venue
- HORMONES
- Published
- 2022-06-02
- Volume
- 21
- Issue
- 4
- Pages
- 537-543
- ISSN
- 1109-3099 (ISSN-L)
- 2520-8721
- PMC
- PMC9712340
- OpenAlex
- W4281740571
- Cited by
- 9
- References
- 63
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 2 · 2023: 1 · 2022: 1
- FWCI
- 0.25
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- HORMONES (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, cc-by)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- Funders
- Università degli Studi di Roma La Sapienza
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- levothyroxine, differentiated thyroid cancer, TSH suppression, thyroidectomy, individualized dosing, triiodothyronine, drug interactions, recurrence risk, treatment optimization
- MeSH terms
- Humans, Hypothyroidism, Thyroid Neoplasms, Thyrotropin, Thyroxine, Triiodothyronine, Adenocarcinoma, Follicular
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