Lean Body Mass is a Predictor of the Daily Requirement for Thyroid Hormone in Older Men and Women
Abstract
Levothyroxine (T 4 ) replacement need in adults with primary hypothyroidism has recently been reported to fall with age. Previous studies have demonstrated that the resting metabolic rate falls with age in euthyroid adults and that this fall is proportional to a reduction in lean body mass (LBM). Since LBM is correlated also with 24‐hour energy expenditure, this study examined the possibility that LBM might be an accurate predictor of T 4 requirement. Seventy‐five hypothyroid adults receiving full replacement therapy, ranging in age from 24 to 88 years, were studied retrospectively. Lean body mass was found to be a better predictor of T 4 requirement than age or weight for the entire group as well as for subgroups of men and women 51 years old and older. The age‐related reduction in LBM may be responsible for the reported decrease in the rate of fractional thyroxine degradation with age.
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LT4 replacement doses tend to decrease with age when they are titrated based on serum TSH.
“LT4 replacement doses tend to decrease with age when they are titrated based on serum TSH (213,215,216,219,220).”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [219]
Most studies examining factors affecting LT4 dose were retrospective chart reviews, but some were prospective.
“Most studies examining this issue were retrospective chart reviews (47,212-224), but some studies were prospective (38,225-229).”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [219]
Studies suggest lean body mass is a better predictor of LT4 requirements, with around 2.3 mg/kg per day.
“While there are no specific guidelines for hypothyroidism and obesity, studies suggest lean body mass is a better predictor, with around 2.3 mg/kg per day.97,99,100”
From Refractory hypothyroidism: unraveling the complexities of diagnosis and management (2023) · cites this paper as [100]
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- Authors
- CUNNINGHAM, J. J., & BARZEL, U. S.
- Affiliations
- Yale University (US)
- Albert Einstein College of Medicine (US)
- Corresponding author
- BARZEL, URIEL S.
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 1984-03
- Volume
- 32
- Issue
- 3
- Pages
- 204-207
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- OpenAlex
- W2049694587
- Cited by
- 80
- References
- 21
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2023: 5 · 2022: 4 · 2021: 7 · 2020: 1 · 2019: 1 · 2018: 2 · 2017: 2 · 2016: 5 · 2015: 1 · 2014: 5 · 2013: 1 · 2012: 3
- FWCI
- 1.70
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Rocky Mountain Research Station
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- lean body mass, levothyroxine, thyroid hormone replacement, primary hypothyroidism, age-related metabolic decline, resting metabolic rate, energy expenditure, older adults, sex differences
- MeSH terms
- Age Factors, Aged, Basal Metabolism, Body Weight, Female, Humans, Hypothyroidism, Male, Middle Aged, Prognosis, Sex Factors, Thyroxine
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