Predicting thyroxine requirements following total thyroidectomy: Thyroxine dose prediction
Open accessAbstract
OBJECTIVE: Optimal thyroxine replacement following total thyroidectomy is critical to avoid symptoms of hypothyroidism. The aim of this study was to determine the best formula to determine the initiated replacement dose of levothyroxine immediately following total thyroidectomy. DESIGN: Prospective study. All patients were initiated on 100 μg levothyroxine and titrated to within the reference range for TSH and free T4. Correlations to height, weight, age, lean body mass (LBM), body surface area (BSA) and body mass index (BMI) were calculated. PATIENTS: One hundred consecutive adult patients underwent total thyroidectomy for non-malignant disease. MEASUREMENTS: Comparison between three methods of levothyroxine dose prediction, aiming for a levothyroxine dose correct to within 25 μg of actual dose required. RESULTS: Correlations were seen between levothyroxine dose and patient age (r=-0.346, P<0.01), bodyweight (r=0.296, P<0.01), LBM (r=0.312, P<0.01), BSA (r=0.319, P<0.01) and BMI (r=0.172, P<0.05). A regression equation was calculated (predicted levothyroxine dose=[0·943 × bodyweight] + [-1.165 × age] + 125.8), simplified to (levothyroxine dose= bodyweight - age + 125) pragmatically. Initiating patients empirically on 100 μg post-operatively showed that 40% of patients achieved target within 25 μg of their required dose; this increased to 59% when using a weight-only dose calculation (1.6 μg/kg) and to 72% using the simplified regression equation. CONCLUSIONS: A simple calculated regression equation gives a more accurate prediction of initiated levothyroxine dose following total thyroidectomy, reducing the need for outpatient attendance for dose titration.
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In a prospective study involving 100 post-thyroidectomy patients, the optimal dose of levothyroxine (μg) could be predicted using the formula: dose = weight (kg) − age (years) + 125.
“In a prospective study involving 100 post-thyroidectomy patients, the optimal dose of levothyroxine (µg) could be predicted using a simple formula: dose = weight (kg) − age (years) + 125”
From Diagnosis and management of treatment-refractory hypothyroidism: an expert consensus report (2017) · cites this paper as [72]
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Diagnosis and management of treatment-refractory hypothyroidism: an expert consensus report
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- Authors
- Mistry, D., Atkin, S., Atkinson, H., Gunasekaran, S., Sylvester, D., Rigby, A. S., & England, R. J.
- Affiliations
- Castle Hill Hospital (GB)
- Hull Royal Infirmary (GB)
- University of Hull (GB)
- Corresponding author
- Mistry, Dipan
- England, R James
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2011-02-08
- Volume
- 74
- Issue
- 3
- Pages
- 384-387
- ISSN
- 0300-0664 (ISSN-L)
- OpenAlex
- W1640899480
- Cited by
- 50
- References
- 20
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 6 · 2023: 3 · 2022: 3 · 2021: 7 · 2019: 4 · 2018: 4 · 2017: 3 · 2016: 1 · 2015: 5 · 2014: 3 · 2013: 2 · 2012: 2
- FWCI
- 2.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Endocrinology (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
- total thyroidectomy, levothyroxine dose, thyroxine replacement, dose prediction, regression equations, body weight, lean body mass, body surface area, body mass index, age, hypothyroidism, dose titration
- MeSH terms
- Adolescent, Adult, Age Factors, Aged, Analysis of Variance, Body Weight, Dose-Response Relationship, Drug, Female, Humans, Hypothyroidism, Male, Middle Aged, Regression Analysis, Thyroid Diseases, Thyroidectomy, Thyrotropin, Thyroxine, Time Factors, Hormone Replacement Therapy, Young Adult
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