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Cited by 23Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryThyroid Cancer Diagnosis and Treatment

Out-of-Reference range thyroid-stimulating hormone levels in levothyroxine-treated primary hypothyroid patients: a multicenter observational study

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Yavuz, Dilek Gogas, Yazıcı, Dilek, Keskin, Lezzan, Atmaca, Ayşegül, Sancak, Seda, Saraç, Fulden, Şahin, İbrahim, Dikbaş, Oğuz +6 more·2017·Frontiers in Endocrinology
DOI 10.3389/fendo.2017.00215PMC PMC5600911
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Abstract

Objective: Although, levothyroxine (LT4) replacement therapy for hypothyroidism has been established as safe, inexpensive and effective, many studies from different countries reported out-of-reference range thyroid stimulating hormone (TSH) values for the hypothyroid patients under LT4 treatment. The aim of this study was to determine TSH levels of primary hypothyroid patients under LT4 treatment and to assess self-reported compliance with daily LT4 intake in tertiary care centers in Turkey. Design: In this cross-sectional, observational study, adult patients with primary hypothyroidism, receiving LT4 treatment for at least 6 months, were included. The patients were from 12 tertiary care centers in 9 cities of Turkey. TSH and free T4 levels were recorded from patient files and self-reported compliance with daily LT4 intake was assessed by interviewing the subjects at the last visit. Results: A total of 1755 subjects (46±13 years; F/M: 89.9%/10.1%) with primary hypothyroidism were enrolled. Of the hypothyroid subjects, 44.8% had out-of-reference range serum TSH levels. TSH values were over the reference range (TSH > 4 mIU/L) in 26.2% and were under the reference range (TSH < 0.5mIU/L) in 18.6% of the patients. Total duration of LT4 treatment was 5.9±4.7 years and mean dose was 1.2±0.6 µg/kg/day. Non-compliant patients (31.1%) had higher TSH levels (6.9±16mIU/L vs 3.8±.9mIU/L, P=0.01) compared to compliant patients. Conclusions: The results of this study revealed that nearly half of the hypothyroid patients had out-of-reference range serum TSH values despite under LT4 treatment. Compliance with LT4 treatment seems to be one of the major determinants to reach the target TSH levels in hypothyroid patients.

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  • A study found that 26% of hypothyroid patients had elevated TSH, and patients with low adherence (31%) had higher TSH than adherent patients.

    “A study demonstrated that 26% of patients with hypothyroidism had elevated TSH levels, and patients with low treatment adherence (31%) had even higher levels compared to adherent patients, highlighting treatment nonadherence as a major obstacle to achieving optimal TSH levels.42”

    From Refractory hypothyroidism: unraveling the complexities of diagnosis and management (2023) · cites this paper as [42]

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Authors
Yavuz, D. G., Yazıcı, D., Keskin, L., Atmaca, A., Sancak, S., Saraç, F., Şahin, İ., Dikbaş, O., Hekimsoy, Z., Yalın, S., Uygur, M., Yılmaz, M., Yirmibeşcik, S., & Asmaz, Ö.
Affiliations
  • Marmara University (TR)
  • Malatya Devlet Hastanesi (TR)
  • Fatih Sultan Mehmet Eğitim Ve Araştırma Hastanesi (TR)
  • Ege University (TR)
  • Manisa Celal Bayar University (TR)
  • Giresun İl Sağlık Müdürlüğü (TR)
  • Tekirdağ Namık Kemal University (TR)
ORCID
Venue
Frontiers in Endocrinology
Publisher
Frontiers Media SA
Published
2017-09-12
Volume
8
Pages
215-215
ISSN
1664-2392 (ISSN-L)
DOI
10.3389/fendo.2017.00215
PMC
PMC5600911
OpenAlex
W2756429786
Cited by
23
References
27
Citations by year
2026: 1 · 2025: 4 · 2024: 3 · 2023: 5 · 2022: 6 · 2021: 3 · 2018: 1
FWCI
0.22
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Frontiers in Endocrinology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DSpace@Giresun (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Dspace Repository (Marmara Üniversitesi) (submittedVersion, other-oa)
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-stimulating hormone, medication adherence, free thyroxine, thyroid hormone replacement, TSH suppression

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