Serum Thyrotropin In Primary Hypothyroidism: A Reliable And Accurate Predictor Of Optimal Daily Levothyroxine Dose
Abstract
Objective To assess the reliability and accuracy of the predicted optimal daily levothyroxine (LT4) dose based on pretreatment serum thyrotropin (thyroid-stimulating hormone or TSH) level in primary hypothyroidism.Methods We examined the relationships between the actual daily LT4 dose required to attain and maintain normal serum TSH concentration and the calculated daily LT4 dose, based on previously established correlations with pretreatment serum TSH concentrations, in 108 consecutive patients with primary hypothyroidism treated in an endocrinology clinic during an 18-month period.Results Highly significant correlations were noted between the optimal daily LT4 dose and the calculated dose based on either logarithmic regression (r = 0.86; P<0.00001) or linear regression (r = 0.83; P<0.00001). Moreover, the actual mean daily LT4 dose (133 +/- 4 mg) approximated the mean doses predicted by both regression analyses (129 +/- 5 mg and 126 +/- 5 mg, respectively) and was identical in many of the study subjects.Conclusion The predicted optimal daily LT4 dose based on pretreatment serum TSH level provides a reliable and accurate approximation of the final optimal LT4 dose in patients with primary hypothyroidism and therefore may be a more convenient and cost-effective therapeutic approach than the current traditional clinical practice.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The magnitude of the serum TSH elevation in patients newly diagnosed with hypothyroidism has been used to accurately predict a patient's LT4 requirement at the time that their serum TSH was first rendered normal on two successive occasions.
“Indeed, the magnitude of the serum TSH elevation in patients newly diagnosed with hypothyroidism has been used to accurately predict a patient's LT4 requirement at the time that their serum TSH was first rendered normal on two successive occasions (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 [229]
Pretreatment serum TSH may also determine dose requirement.
“Pretreatment serum TSH may also determine dose requirement (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 [229]
Cites
Fish, L. H., Schwartz, H. L., Cavanaugh, J., Steffes, M. W., Bantle, J. P., & Oppenheimer, J. H. (1987) · New England Journal of Medicine · doi:10.1056/nejm198703263161302 · Cited by 353 · see citing works
Levothyroxine Therapy in Patients with Thyroid Disease
Mandel, S. J., Brent, G. A., & Larsen, P. R. (1993) · Annals of Internal Medicine · doi:10.7326/0003-4819-119-6-199309150-00009 · Cited by 324 · see citing works
Levothyroxine Replacement Dose for Primary Hypothyroidism Decreases with Age
ROSENBAUM, R. L., & BARZEL, U. S. (1982) · Annals of Internal Medicine · doi:10.7326/0003-4819-96-1-53 · Cited by 163 · see citing works
'Subclinical hypothyroidism'. Natural course of the syndrome during a prolonged follow-up study
Kabadi, U. M. (1993) · Archives of Internal Medicine · doi:10.1001/archinte.153.8.957 · Cited by 95 · see citing works
Self-citationDavis, F. B. (1984) · Archives of Internal Medicine · doi:10.1001/archinte.1984.00350210064009 · Cited by 64 · see citing works
Kabadi, U. M. (1993) · Archives of Internal Medicine · doi:10.1001/archinte.1993.00410080025004 · Cited by 57 · see citing works
Self-citationOptimal Daily Levothyroxine Dose in Primary Hypothyroidism
Kabadi, U. M. (1989) · Archives of Internal Medicine · doi:10.1001/archinte.1989.00390100045012 · Cited by 23 · see citing works
Self-citationVariability of L-thyroxine replacement dose in elderly patients with primary hypothyroidism.
Kabadi, U. M. (1987) · PubMed · Cited by 20 · see citing works
Self-citationSerum Thyrotropin in Primary Hypothyroidism
Kabadi, U. M. (1995) · Archives of Internal Medicine · doi:10.1001/archinte.1995.00430100070008 · Cited by 17 · see citing works
Self-citationClinical Hypothyroidism in the Elderly—A Preventable Disorder?*
Rosenbaum, R. L., & Barzel, U. S. (1981) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1981.tb01770.x · Cited by 17 · see citing works
Kabadi, U. M. (1997) · Southern Medical Journal · doi:10.1097/00007611-199709000-00012 · Cited by 10 · see citing works
Self-citationKabadi, U. M., & Cech, R. F. (1997) · Journal of Endocrinological Investigation · doi:10.1007/bf03350310 · Cited by 8 · see citing works
Self-citationOptimal LT4 dosage in primary hypothyroidism.
Kabadi, U. M. (1994) · PubMed · Cited by 2 · see citing works
Self-citation
Flagged first, then by citations
1 of the 14 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Jonklaas, J., Bianco, A. C., Bauer, A. J., Burman, K. D., Cappola, A. R., Celi, F. S., Cooper, D. S., Kim, B. W., Peeters, R. P., Rosenthal, M. S., et al. (2014) · Thyroid® · doi:10.1089/thy.2014.0028 · Cited by 1,928 · see citing works
Levothyroxine Dose Adjustment to Optimise Therapy Throughout a Patient’s Lifetime
Duntas, L. H., & Jonklaas, J. (2019) · Advances in Therapy · doi:10.1007/s12325-019-01078-2 · Cited by 94 · see citing works
Sex and Age Differences in Levothyroxine Dosage Requirement
Jonklaas, J. (2010) · Endocrine Practice · doi:10.4158/ep09257.or · Cited by 72 · see citing works
Optimizing Treatment of Hypothyroidism
Clarke, N., & Kabadi, U. M. (2004) · Treatments in Endocrinology · doi:10.2165/00024677-200403040-00003 · Cited by 27 · see citing works
Self-citationSingh, R., Tandon, A., & Awasthi, A. (2021) · Hormone and Metabolic Research · doi:10.1055/a-1336-3502 · Cited by 6 · see citing works
Jonklaas, J. (2019) · Springer eBooks · doi:10.1007/978-3-319-72102-6_19 · Cited by 6 · see citing works
Zhang, Q., Zhang, Y., Zhu, H., Liu, K., Lou, P., Kong, P., Su, L., & Wang, S. (2023) · Endocrine Metabolic & Immune Disorders - Drug Targets · doi:10.2174/1871530323666230821102730 · Cited by 4 · see citing works
Clinical Practice Recommendations for Assessment and Management of Hypothyroidism
Alsifri, S. N., Aljuhani, N. R., Al-Jedai, A. H., Nasser, T., Alsabaan, F., Almudaiheem, H., Amir, A., Baissa, E., Ghannam, N., Aldawish, M., et al. (2022) · International Journal of Clinical Medicine · doi:10.4236/ijcm.2022.1312046 · Cited by 4 · see citing works
Determining Treatment Dosage for Hypothyroidism Using Machine Learning
Zammit, C., & Sykes, E. R. (2025) · Computational Intelligence · doi:10.1111/coin.70060 · Cited by 1 · see citing works
Dosis de levotiroxina varía según la etiología del hipotiroidismo y el peso corporal
Barrera, C. A. B., Bayona, K. L. P., & Barragán, F. A. J. (2017) · Revista Colombiana de Endocrinología Diabetes & Metabolismo · doi:10.53853/encr.1.1.58
Luíz, H. V., Manita, I., & Portugal, J. (2016) · Springer eBooks · doi:10.1007/978-3-319-25871-3_7
&NA; (2005) · Drugs & Therapy Perspectives · doi:10.2165/00042310-200521080-00003
Elsherbiny, T. M. (2024) · The Egyptian Journal of Internal Medicine · doi:10.1186/s43162-024-00305-9
Replacement Therapy for Hypothyroidism: Purpose and Indication for Correction
Степановна, М. Н., Алексеевич, Т. А., Matveyeva, Y. О., Олеговна, Щ. А., Кузина, И. А., Валерьевна, Г. Е., Эдуардовна, Т. М., & Petunina, N. A. (2024) · Effective Pharmacotherapy · doi:10.33978/2307-3586-2024-20-8-64-69
- Authors
- Kabadi, U. M., & Kabadi, M. M.
- Affiliations
- United States Department of Veterans Affairs (US)
- Corresponding author
- Kabadi, Udaya M.
- ORCID
- Kabadi, Udaya M.
- Venue
- Endocrine Practice
- Publisher
- Elsevier BV
- Published
- 2001-01
- Volume
- 7
- Issue
- 1
- Pages
- 16-18
- ISSN
- 1530-891X (ISSN-L)
- OpenAlex
- W2013974286
- Cited by
- 14
- References
- 14
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 1 · 2022: 1 · 2021: 1 · 2019: 2 · 2017: 1 · 2016: 1 · 2014: 1
- FWCI
- 0.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Endocrine Practice (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 › Thyroid Cancer Diagnosis and Treatment
- Keywords
- primary hypothyroidism, levothyroxine dose, thyroid-stimulating hormone, serum TSH, dose prediction, dose titration, logarithmic regression, linear regression, thyroid hormone replacement
- MeSH terms
- Humans, Hypothyroidism, Thyrotropin, Thyroxine, Biomarkers, Linear Models
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
