Levothyroxine Replacement Therapy in Central Hypothyroidism: A Practice Report
Abstract
Because of lack of well‐documented laboratory criteria, we assessed the usefulness of measuring free thyroxine (FT 4) levels for monitoring levothyroxine replacement therapy in patients with central hypothyroidism. This consisted of a retrospective review from 1991–1997 of patient profiles extracted into a Macintosh 4th Dimension data base from the medical information system at a tertiary care biomedical research facility. Information was also retrieved from medical records of 135 ambulatory patients treated by 42 endocrinology practitioners, and 52 ambulatory patients treated by 20 endocrinology practitioners for central and primary hypothyroidism, respectively. Patient profiles were reviewed for most recent thyroid function test results and levothyroxine dosing information. Of 112 (83%) patients with central hypothyroidism who had FT 4 levels within the laboratory's reference interval, only 2 had a dosage change. The FT 4 concentration was concordant with physician‐assessed thyroid status in 65 (82%) of 79 patients (95% CI 72–90, p<0.02) for whom clinical assessment was available in medical records. Thyrotropin, total thyroxine, and triiodothyronine levels were not significantly associated with clinical status (p>0.12) in patients with central hypothyroidism. Despite similar demographic and levothyroxine dosing profiles, patients with central hypothyroidism had significantly lower serum FT 4 and thyrotropin concentrations than those with primary hypothyroidism. The appropriateness of levothyroxine replacement therapy in most patients with central hypothyroidism is reflected by a normal FT 4 concentration measured with a valid assay. Whether midnormal or upper normal values are necessary for optimal therapy, and whether the therapeutic goal should be different in children than in adults, require prospective studies with independent, objective assessment of thyroid status.
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Low TSH values are more likely to be associated with adequate replacement in CeH patients.
“A couple of groups also reported that low TSH values are more likely to be associated with adequate replacement in CeH patients [61, 62].”
From 2018 European Thyroid Association (ETA) Guidelines on the Diagnosis and Management of Central Hypothyroidism (2018) · cites this paper as [61]
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- Authors
- Carrozza, V., Csako, G., Yanovski, J. A., Skarulis, M. C., Nieman, L., Wesley, R., & Pucino, F.
- Affiliations
- National Institutes of Health (US)
- Corresponding author
- Pucino, Frank
- Venue
- Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
- Publisher
- Wiley
- Published
- 1999-03
- Volume
- 19
- Issue
- 3
- Pages
- 349-355
- ISSN
- 0277-0008 (ISSN-L)
- 1875-9114
- OpenAlex
- W2139557062
- Cited by
- 36
- References
- 26
- Citations by year
- 2026: 1 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 1 · 2016: 1 · 2015: 1 · 2014: 5 · 2013: 1 · 2012: 3
- FWCI
- 0.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy (publishedVersion)
- PubMed (publishedVersion)
- 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 › Adrenal Hormones and Disorders
- Keywords
- levothyroxine, central hypothyroidism, free thyroxine, thyroid function monitoring, levothyroxine dosing, thyroid-stimulating hormone, total thyroxine, triiodothyronine, primary hypothyroidism
- MeSH terms
- Adult, Female, Humans, Hypothyroidism, Male, Middle Aged, Retrospective Studies, Thyroid Function Tests, Thyroxine
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