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Cited by 31Thyroid and Parathyroid SurgeryThyroid Disorders and TreatmentsThyroid Cancer Diagnosis and Treatment

Individually-tailored thyroxine requirement in the same patients before and after thyroidectomy: a longitudinal study

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Del Duca, S C, Santaguida, M G, Brusca, N, Gatto, I, Cellini, M, Gargano, L, Verga Falzacappa, C, Frattaroli, F M +2 more·2015·European Journal of Endocrinology
DOI 10.1530/eje-15-0314
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Abstract

OBJECTIVE: Thyroxine (T4) requirement after total thyroidectomy for differentiated thyroid carcinoma (DTC) is a debated issue. As most of the studies in the area have been retrospective and/or performed with heterogeneous therapeutic approaches, we designed our study to determine T4 requirement in the same patients and treatment settings, before and after total thyroidectomy. DESIGN, PATIENTS AND METHODS: This was a longitudinal study including 23 goitrous patients treated with T4 in an individually tailored fashion. All patients exhibited a stable TSH (median TSH = 0.28 mU/l) at a stable T4 dose for at least 1 year before surgery (median T4 dose = 1.50 μg/kg per day). The patients underwent total thyroidectomy based on cancer suspicion or compressive symptoms. Eventually diagnosed as having DTC (pT1b-pT2N0) and following surgical and radiometabolic treatment, they were treated with the same pre-surgical doses of T4. RESULTS: Three months after surgery,using the same pre-surgical dose, median TSH increased up to 5.38 mU/l (P<0.0001) and so the T4 dose had to be increased (median T4 dose = 1.95 μg/kg per day; +30%; P < 0.0001). Once divided by patients' age, we observed that, after thyroidectomy and maintaining the same pre-surgical dose, serum TSH significantly increased both in younger and in older patients (median TSH = 4.57 and 6.11 mU/l respectively). Serum TSH was restored to the pre-surgical level by increasing the dose up to 1.95 and 1.77 μg/kg per day (+25 and +21%) respectively. CONCLUSIONS: Following the same treatment regimen, a thyroidectomized patient requires one-third higher therapeutic T4 dose than before surgery. Despite this increase, the dose of T4 needed in our patients remains significantly lower than that previously described in athyreotic patients.

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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 [105]

    The Clinical Study passage reports that increasing T4 by 25% in patients under 50, and by 21% in older patients, restored presurgical TSH levels; FT4 levels were also similar before and after surgery. But the Results report a 30% median increase for the full group, so “up to 25%” is not an accurate upper limit for the study's patients. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • In longitudinal studies, the reduction in FT3 and increased FT4/FT3 ratio after thyroidectomy was not confirmed between pre- and post-thyroidectomy.

    “However, in longitudinal studies, this reduction was not confirmed between pre- and post-thyroidectomy (104, 105).”

    From ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism (2025) · cites this paper as [105]

    The Results and Clinical Study passages (page not provided) report no statistically significant change in median FT3 before versus after thyroidectomy once the T4 dose was adjusted, although some patients had lower postoperative FT3. The paper reports FT4 and FT3 separately but does not establish that an increased FT4/FT3 ratio was also unconfirmed. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • In individuals established on Levothyroxine, dose requirement falls with age.

    “There is also evidence that in individuals established on Levothyroxine, dose requirement falls with age [19, 20].”

    From Age-related variation in thyroid function – a narrative review highlighting important implications for research and clinical practice (2023) · cites this paper as [20]

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Authors
Del Duca, S. C., Santaguida, M. G., Brusca, N., Gatto, I., Cellini, M., Gargano, L., Verga Falzacappa, C., Frattaroli, F. M., Virili, C., & Centanni, M.
Affiliations
Policlinico Umberto I (IT)
Corresponding author
Centanni, M
ORCID
Venue
European Journal of Endocrinology
Publisher
Oxford University Press (OUP)
Published
2015-09
Volume
173
Issue
3
Pages
351-357
ISSN
  • 0804-4643 (ISSN-L)
  • 1479-683X
DOI
10.1530/eje-15-0314
OpenAlex
W2100955331
Cited by
31
References
34
Citations by year
2025: 3 · 2024: 3 · 2023: 1 · 2022: 2 · 2021: 3 · 2020: 1 · 2019: 6 · 2018: 5 · 2017: 3 · 2016: 3 · 2015: 1
FWCI
4.04
Type
journal article
Language
en
Open access
Locations
  • European Journal of Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
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, differentiated thyroid cancer, TSH response, post-thyroidectomy hypothyroidism, goiter, thyroid hormone replacement
MeSH terms
Carcinoma, Dose-Response Relationship, Drug, Female, Humans, Hypothyroidism, Longitudinal Studies, Male, Middle Aged, Postoperative Period, Thyroid Neoplasms, Thyroidectomy, Thyrotropin, Thyroxine, Hormone Replacement Therapy, Preoperative Period, Precision Medicine

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