Low-Normal or High-Normal Thyrotropin Target Levels During Treatment of Hypothyroidism: A Prospective, Comparative Study

Boeving, Anke; Paz-Filho, Gilberto; Radominski, Rosana Bento; Graf, Hans; de Carvalho, Gisah Amaral

doi:10.1089/thy.2010.0315

Cited by 58Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryThyroid Cancer Diagnosis and Treatment

Low-Normal or High-Normal Thyrotropin Target Levels During Treatment of Hypothyroidism: A Prospective, Comparative Study

Boeving, Anke, Paz-Filho, Gilberto, Radominski, Rosana Bento, Graf, Hans, de Carvalho, Gisah Amaral·2011·Thyroid

DOI 10.1089/thy.2010.0315

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Abstract

BACKGROUND: Recent literature advocates the decrease of the upper limit of the normal thyrotropin (TSH) reference range. The objective of this study was to determine whether treated hypothyroid patients maintained within a low-normal TSH range (0.4-2.0 mIU/L) have better clinical outcomes than those maintained within a high-normal TSH range (2.0-4.0 mIU/L). METHODS: The study was performed in a thyroid outpatient clinic of a tertiary hospital. This was a prospective, interventional study. Forty-two participants with newly diagnosed overt primary hypothyroidism were paired in two groups: group 1 (n=20), low-normal target TSH; group 2 (n = 22), high-normal target TSH. Levothyroxine was initiated, and dose was adjusted to achieve and sustain the target TSH value during the study period. After the target TSH was reached, participants were evaluated every 3 months for thyroid function, serum lipid profile, resting energy expenditure (REE), body composition, and bone mineral density, for 12 months. RESULTS: Nineteen patients in group 1 and 16 in group 2 completed the study. In the whole-group analysis, total cholesterol (p = 0.01), low-density lipoprotein cholesterol (p = 0.004), and triglycerides (p < 0.001) decreased after treatment, whereas REE per kilogram of lean body mass (p = 0.001) and total fat body mass (p =0.02) increased. Group 1 patients had a significantly higher relative increase in REE (+7.1% ± 11.3% vs. +3.6% ± 15.1%, p = 0.02). There was no difference between the groups in the other variables. CONCLUSIONS: Despite recent trends toward lowering the upper limit of normal TSH range, the results of this 12-month study provided no substantial clinical evidence to corroborate that treatment of primary hypothyroidism should aim at maintaining TSH levels in a low-normal range

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In two studies of energy expenditure in LT4-treated euthyroid subjects, REE increased as LT4 doses were adjusted to lower TSH levels within the reference range.
“In two studies of energy expenditure in LT4-treated euthyroid subjects, REE increased as LT4 doses were adjusted to lower TSH levels within the reference range (25,26).”
From Effects of levothyroxine replacement or suppressive therapy on energy expenditure and body composition (2016) · cites this paper as [26]

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EFFECT OF THYROXINE ON LDL AND TOTAL CHOLESTEROL IN HYPOTHYROID PATIENTS
John, N. N. (2012)

Authors: Boeving, A., Paz-Filho, G., Radominski, R. B., Graf, H., & de Carvalho, G. A.
Affiliations: Hospital de Clínicas Universidade Federal do Paraná (BR)
Australian National University (AU)
SEMPR, Serviço de Endocrinologia e Metabologia, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil.
ORCID: Paz-Filho, Gilberto
Radominski, Rosana Bento
Graf, Hans
Venue: Thyroid
Publisher: SAGE Publications
Published: 2011-04
Volume: 21
Issue: 4
Pages: 355-360
ISSN: 1050-7256 (ISSN-L)
1557-9077
DOI: 10.1089/thy.2010.0315
OpenAlex: W1983589077
Cited by: 58
References: 34
Citations by year: 2026: 3 · 2025: 3 · 2024: 3 · 2023: 3 · 2022: 2 · 2021: 3 · 2019: 6 · 2018: 3 · 2017: 6 · 2016: 4 · 2015: 2 · 2014: 4 · 2013: 9 · 2012: 5
FWCI: 4.98
Type: journal article
Language: en
Open access: closed
Licence: www.liebertpub.com/nv/resources-tools/text-and-data-mining-policy/121/ (tdm)
Locations: Thyroid (publishedVersion)
PubMed (publishedVersion)
ANU Open Research (Australian National University) (submittedVersion)
Funders: Universidade Federal do Paraná
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: primary hypothyroidism, TSH reference range, levothyroxine dose adjustment, resting energy expenditure, body composition, bone mineral density, serum lipids, triglycerides, LDL cholesterol, total cholesterol
MeSH terms: Adult, Aged, Aged, 80 and over, Female, Humans, Hypothyroidism, Male, Middle Aged, Prospective Studies, Reference Values, Thyrotropin, Thyroxine

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Low-Normal or High-Normal Thyrotropin Target Levels During Treatment of Hypothyroidism: A Prospective, Comparative Study

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