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Cited by 49Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryThyroid Cancer Diagnosis and Treatment

How good is the levothyroxine replacement in primary hypothyroidism patients in Brazil? Data of a multicentre study

Vaisman·2014·PubMed
DOI 10.3275/8810
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Abstract

BACKGROUND: Studies from every continent have shown that only around 50% of the patients subjected to thyroid hormone replacement have TSH in the normal range. However, to date, there are no consistent data about Brazil. OBJECTIVES: To evaluate levothyroxine (LT4) replacement treatment in patients with primary hypothyroidism followed in referral centers in Brazil. METHODS: Patients with primary hypothyroidism followed in referral centers (University Hospitals from Universidade Federal do Rio de Janeiro - UFRJ, Unicamp, Universidade Federal do Paraná - UFPR and Universidade Federal do Ceará-UFC) answered a questionnaire that inquired about clinical and biochemical conditions, social- economic status, life quality and clinicians' orientations as well as their understanding about the information given. Serum TSH was checked close to the interview. RESULTS: 2292 consecutive patients met the inclusion criteria. Mean age 51.2 yr and TSH values between 0.4 and 4.0 mUI/l were considered to be within the reference range. Among all patients taking thyroid medication, 42.7% had an abnormal serum TSH (28.3% were undertreated and 14.4% were overtreated). Approximately all patients (99%) took LT4 in the morning but less than 30 min before breakfast (85.4%). Regarding the clinicians' orientations: 97.5% of the patients were instructed to take the medication daily, and 92.6% to take 30 min before breakfast (92.6%). However, only 52.1% were told not to take LT4 along with other medication. CONCLUSIONS: Our study found that a significant number of patients taking thyroid hormones were not in the therapeutic range. Clinicians should, therefore, consider monitoring patients on thyroid replacement more frequently and being more precise on giving recommendations about the correct use of LT4.

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  • Five to 24 percent of all patients taking L-T4 develop iatrogenic thyrotoxicosis, a proportion that is even higher in the elderly (up to 41%).

    “Five to 24 percent of all patients taking L-T4 develop iatrogenic thyrotoxicosis (9, 11, 78, 81–83), a proportion that is even higher in the elderly [up to 41% (79)].”

    From Levothyroxine therapy in elderly patients with hypothyroidism (2021) · cites this paper as [83]

  • Approximately 20% of patients with primary hypothyroidism and approximately 20% or 40% of patients with central hypothyroidism are undertreated, with co-administration of interfering medications being one major cause.

    “≈20% of patients with PH (10–13) and ≈20% (14) or 40% (15) of patients with CH are undertreated, co-administration of interfering medications (IM) being one major cause.”

    From L-T4 therapy in the presence of pharmacological interferents (2020) · cites this paper as [12]

  • Only 52.1% of patients were told not to take L-T4 along with interfering medications.

    “Strikingly, only 52.1% of patients were told not to take L-T4 along with IM (12).”

    From L-T4 therapy in the presence of pharmacological interferents (2020) · cites this paper as [12]

  • Of 2,292 patients with primary hypothyroidism, 42.7% had abnormal serum TSH, with 28.3% undertreated and 14.4% overtreated.

    “Of 2,292 patients with PH (12), 42.7% had abnormal serum TSH (28.3% undertreated and 14.4% overtreated).”

    From L-T4 therapy in the presence of pharmacological interferents (2020) · cites this paper as [12]

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Authors
Vaisman
Venue
PubMed
Publisher
National Institutes of Health
Published
2014-03-18
Volume
36
Issue
7
Pages
485-8
DOI
10.3275/8810
OpenAlex
W145192667
Cited by
49
References
25
Citations by year
2026: 1 · 2024: 4 · 2023: 8 · 2022: 3 · 2021: 8 · 2020: 6 · 2019: 3 · 2018: 3 · 2017: 4 · 2016: 5 · 2015: 1 · 2014: 1 · 2013: 2
FWCI
2.36
Type
journal article
Language
en
Open access
closed
Locations
PubMed (publishedVersion)
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, levothyroxine, thyroid hormone replacement, thyroid-stimulating hormone, undertreatment, overtreatment, medication adherence, patient education, referral centers, Brazil
MeSH terms
Adult, Aged, Brazil, Cross-Sectional Studies, Female, Humans, Hypothyroidism, Male, Middle Aged, Thyrotropin, Thyroxine, Hormone Replacement Therapy

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