Levothyroxine Therapy In Patients Research Articles

Editorial: Levothyroxine Therapy in Patients With Hypothyroidism

Editorial: Levothyroxine Therapy in Patients With Hypothyroidism

Adherence to levothyroxine prescription in patients with hypothyroidism.

Hypothyroidism occurs in 1-2% of the general population, is associated with significant morbidity and requires continuous treatment with levothyroxine. To determine the effectiveness, adherence and safety of levothyroxine therapy in patients with hypothyroidism. The Morisky-Green adherence test was applied, and effectiveness was determined by measuring thyroid-stimulating hormone (TSH) in 330 patients with with hypothyroidism; the mean age was 64+-15 years and 76% was women. Median TSH was 2.09 mIU/L (interquartile range: 1.16-3.61 mIU/L). Two hundred thirty-five (71%) patients had TSH levels in the euthyroid range, 64 (19%) in the hypothyroid range and 31 (9%) in the hyperthyroid range. Complete, moderate and lack of adherence with levothyroxine was reported in 283 (86%), 29 (9%) and 18 (5%) of patients, respectively. The presence of anemia (odds ratio (OR): 0.37, 95% confidence intervals (CI): 0.15-0.98) or the need of doses over 100 µg/day (OR: 0.47, 95%CI: 0.28-0.80) increased the probability of having an abnormal TSH level. In a large proportion of these patients, TSH levels were controlled, and most patients were adherent to levothyroxine therapy.

Reversal of nocturnal non-dipping of blood pressure after Levothyroxine therapy in patients with subclinical hypothyroidism

AimsTo study the loss of diurnal variation in blood pressure in normotensive patients with Subclinical/overt hypothyroidism and effect of Levothyroxine (L-T4) treatment. Materials and methodsIn this interventional study Eighty patients between 17- 50 years with newly detected OH and SCH (74 women and 6 men) and nine euthyroid subjects (all men) with blood pressure <140/90 were recruited. All patients underwent 24h ambulatory blood pressure monitoring (ABPM) using ABPM machine before and after treatment with L-T4. Diurnal index (DI), Percent time elevation (PTE), Hyperbaric impact (HBI) were studied pre and post L-T4 treatment. ResultsOf the 89 subjects (22 SCH, 58 OH and 9 controls), 7 of the SCH and 30 of OH subjects reported back in follow up after L-T4 supplementation for evaluation. DI, HBI and PTE when compared at baseline between different groups (SCH- OH, SCH- control, OH- control) were insignificant. After L-T4 supplementation DI, HBI and PTE varied significantly with p value 0.007, 0.003 and 0.003 respectively between SCH- OH only. Post L-T4 analysis in SCH group was statistically insignificant (p-value 0.102) but a trend toward improvement in DI was noted (baseline and post treatment DI mean 7.00 and 13.00 respectively). ConclusionLoss of nocturnal dipping was found in patients with OH and SCH which was restored after L-T4 therapy only in patients with SCH and not with OH. Treatmentof SCH patients with high cardiovascular risk may be beneficial in this setting and can be a new indication for LT4 therapy in SCH.

Delayed TSH recovery after dose adjustment during TSH-suppressive levothyroxine therapy in patients with differentiated thyroid cancer

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Clinical, behavioural and pharmacogenomic factors influencing the response to levothyroxine therapy in patients with primary hypothyroidism\u2014protocol for a systematic review

BackgroundSuboptimal thyroid hormone therapy including under-replacement and over-replacement is common amongst patients with hypothyroidism. This is a significant health concern as affected patients are at risk of adverse cardiovascular or metabolic consequences. Despite a growing body of evidence on the effects of various factors on thyroid hormone replacement, a systematic appraisal of the evidence is lacking. This review aims to appraise and quantify the extent to which clinical, behavioural and pharmacogenomic factors affect levothyroxine therapy in patients with primary hypothyroidism.Methods/designThe databases Web of Science, Cochrane Library, EMBASE and PubMed will be searched. Patients must be adults over the age of 18 years, suffering from primary hypothyroidism including overt and subclinical hypothyroidism and receiving levothyroxine treatment. Studies in children, pregnant women and patients with secondary or tertiary hypothyroidism will not be included. We will also exclude studies focused on forms of thyroid hormone replacement therapy other than levothyroxine.The primary outcome is to quantify the effect of clinical, behavioural and pharmacogenomic factors on thyroid stimulating hormone (TSH) levels. Secondary outcomes are the effect these factors have on thyroxine (T4) and triiodothyronine (T3) levels, mortality, morbidity, quality of life, treatment complications, adverse effects, physical and social functioning. Studies will be screened through reading the title, abstract and then full text. Two reviewers will independently extract the data and select articles, and a third reviewer will be consulted if there is any disagreement. We will undertake a meta-analysis of studies in which there is a defined intervention or exposure, patients are receiving levothyroxine for hypothyroidism, there is an appropriate control group of levothyroxine treated patients that are not exposed to the intervention, and the primary outcome is determined by serum TSH levels. Studies will comprise of randomised controlled trials as well as observational data.Eligible studies will be assessed for bias using the risk of bias tool available in the Cochrane handbook 2011, and the quality of evidence will be judged according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. A flow diagram describing the data search will be created according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis: The PRISMA statement. A narrative synthesis will be undertaken in the description of the data, and summary tables will be created of the results.DiscussionThis review will be the first systematic review of this nature. The evidence synthesised will be useful to general practitioners in their management of hypothyroidism. Findings will be disseminated at conferences and in professional and peer-reviewed journals.Systematic review registrationPROSPERO CRD42015027211

Disease-Specific as Well as Generic Quality of Life Is Widely Impacted in Autoimmune Hypothyroidism and Improves during the First Six Months of Levothyroxine Therapy.

BackgroundHypothyroidism is often diagnosed, and subsequently treated, due to health-related quality of life (HRQL) issues. However, HRQL following treatment has never previously been assessed in longitudinal descriptive studies using validated instruments.ObjectiveTo investigate disease-specific (ThyPRO) and generic (SF-36) HRQL, following levothyroxine therapy in patients with hypothyroidism due to autoimmune thyroiditis.MethodsThis prospective cohort study was set at endocrine outpatient clinics at two Danish university hospitals. Seventy-eight consecutive patients were enrolled and completed HRQL questionnaires before, six weeks, and six months after initiation of levothyroxine therapy. Normative ThyPRO (n = 739) and SF-36 (n = 6,638) data were available for comparison and changes in HRQL following treatment were estimated and quantified.ResultsPrior to treatment, all ThyPRO scales were significantly impacted (p<0.0001), compared to the general population sample. The same was observed for seven of eight SF-36 scales, the exception being Bodily Pain. Tiredness (ThyPRO) and Vitality (SF-36) were the most markedly impacted scales. After six weeks of treatment, nine of thirteen ThyPRO scales had significantly improved. ThyPRO improvements were consistent at six months, where five of eight SF-36 scales had also significantly improved, but deficits persisted for a subset of both ThyPRO and SF-36 scales.ConclusionsIn this population of hypothyroid patients, HRQL was widely affected before treatment, with tiredness as the cardinal impairment according to both ThyPRO and SF-36. Many aspects of HRQL improved during the first six months of LT4 therapy, but full recovery was not obtained. Our results may help clinicians inform patients about expected clinical treatment effects.

Drug interactions with levothyroxine therapy in patients with hypothyroidism: observational study in general practice.

Several drugs may interact with levothyroxine and reduce its bioavailability. The aim of this study was to analyse the Italian general practice patients with hypothyroidism from 2002-2011, in terms of variation of thyroid-stimulating hormone (TSH) levels, number of levothyroxine prescriptions and dose of levothyroxine before and during potential drug-drug interactions (DDIs). Data were extracted from the Italian general practice Health Search CSD Longitudinal Patient Database (HSD). Analysis was limited to individuals aged 18 years and older with at least one levothyroxine prescription from 2002 to 2011 and at least one year of clinical history recorded in HSD. A quasi-experimental pre-post analysis was carried out using a self-controlled study design, on an intention-to-treat basis. Overall, 5,426 levothyroxine users (7.5 % of population in HSD) were included in the study. The incidence rate ratio comparing the TSH trend before and during the period of exposure to potential DDI showed a significant increase of TSH levels during initial exposure to potential DDI, which decreased over time. The number of prescriptions and dose of levothyroxine decreased before the potential DDI and increased symmetrically during the period of exposure to potential DDI. The co-prescription of levothyroxine and potentially interacting drugs results in an increased use of levothyroxine. Clinicians should carefully consider adjusting levothyroxine therapy in presence of concomitant drugs, such as proton-pump inhibitors, which may reduce levothyroxine bioavailability.

The usefulness of thyroid function tests for the estimation of individual sensitivity to levothyroxine therapy in patients with thyroid cancer

The usefulness of thyroid function tests for the estimation of individual sensitivity to levothyroxine therapy in patients with thyroid cancer

A Low Postoperative Nonstimulated Serum Thyroglobulin Level Does Not Exclude the Presence of Radioactive Iodine Avid Metastatic Foci in Intermediate-Risk Differentiated Thyroid Cancer Patients

Postsurgical thyrotropin (TSH)-stimulated serum thyroglobulin (Tg) level can be used to predict the likelihood of finding radioactive iodine (RAI) avid metastatic foci on postablation scanning. However, there is little data regarding the predictive value of a nonstimulated postoperative Tg obtained on levothyroxine therapy in patients being considered for recombinant human TSH (rhTSH)-assisted remnant ablation. The study included 290 intermediate-risk differentiated thyroid cancer (DTC) patients with a postsurgical nonstimulated Tg<10 ng/mL prior to rhTSH-assisted remnant ablation. Patients were stratified into four groups based on the postsurgical nonstimulated Tg value: Tg<0.6 ng/mL (n=146), Tg 0.6-0.9 ng/mL (n=76), Tg 1-5 ng/mL (n=51), and Tg>5-10 ng/mL (n=17). RAI avid metastatic foci were identified using post-therapy scanning with SPECT/CT (single photon emission computed tomography). RAI avid metastases were identified in 16% (46/290) of patients, including 12% (17/146) with Tg<0.6 ng/mL, 14% (11/76) with Tg 0.6-0.9 ng/mL, 25% (13/51) with Tg 1-5 ng/mL, and 29% (5/17) with Tg>5-10 ng/mL (p=0.02). While 99% of the RAI avid foci were located in the neck, lung uptake was seen in one patient with Tg<0.6 ng/mL (0.7%, 1/146), one patient with Tg 0.6-0.9 ng/mL (1.3%, 1/76), and 2 patients with Tg>5-10 ng/mL (11%, 2/17 patients). A postoperative nonstimulated Tg<0.6 ng/mL does not exclude identification of RAI avid metastatic foci on postablation SPECT/CT scanning in intermediate-risk DTC patients. Therefore, patient selection for RAI ablation in the intermediate-risk group must be based on an integration of multiple risk factors rather than any single clinicopathologic risk factor.

Prophylactic levothyroxine therapy in patients with Hashimoto's thyroiditis.

Prophylactic levothyroxine therapy in patients with Hashimoto's thyroiditis.

Variations In Adequate Levothyroxine Replacement Therapy In Patients With Different Causes Of Hypothyroidism

To compare the levothyroxine replacement dose in 181 patients with various causes of hypothyroidism. We analyzed the dose of levothyroxine used in the following five patient groups: (1) 37 patients with hypothyroidism after radioiodine therapy for Graves' thyrotoxicosis who were receiving a stable (for at least 4 years) replacement dose (mean time after 131 I therapy, 11.3 years); (2) 36 patients with Hashimoto's hypothyroidism (chronic autoimmune thyroiditis with a goiter or positive test results for antithyroid antibodies); (3) 36 patients with central hypothyroidism; (4) 36 patients with hypothyroidism after near-total thyroidectomy and 131 I therapy for thyroid carcinoma with negative total-body 131 I scans who were euthyroid when receiving levothyroxine; and (5) 36 patients with atrophic thyroiditis (no goiter and negative test results for antithyroid antibodies). Adequacy of levothyroxine replacement dose was defined as a normal thyrotropin level and clinical euthyroidism in patients with primary hypothyroidism and a serum free thyroxine index in the upper half of the normal range in conjunction with clinical euthyroidism in patients with central hypothyroidism. The mean (+/- standard error of the mean) replacement dosage of levothyroxine (mg/kg per day) in patients with atrophic thyroiditis (1.26 +/- 0.07) was lower (P<0.05) than in patients with Hashimoto's hypothyroidism (1.59 +/- 0.07) and those with hypothyroidism after radioiodine therapy (1.56 +/- 0.05). These doses, in turn, were lower (P<0.01) than those in patients with central hypothyroidism (1.88 +/- 0.10) or euthyroid thyroid carcinoma (2.08 +/- 0.07). In a separate analysis, the levothyroxine dose in 43 patients with hypothyroidism after 131 I treatment was evaluated serially over time. The mean levothyroxine dosage increased from 0.87 +/- 0.12 at 6 months after 131 I therapy to 1.57 +/- 0.09 at 7 years (P<0.001). The serum thyrotropin concentration (in mU/mL) during levothyroxine therapy in patients with central hypothyroidism (0.31 +/- 0.08) was lower (P<0.01) than in patients with hypothyroidism after 131 I therapy (1.69 +/- 0.37), Hashimoto's hypothyroidism (1.39 +/- 0.20), atrophic thyroiditis (1.86 +/- 0.22), and euthyroid thyroid carcinoma (1.48 +/- 0.26). The levothyroxine replacement dose varies with the cause of the hypothyroidism.

Levothyroxine Therapy in Patients with Thyroid Disease

Purpose: To review the indications for and the proper monitoring of levothyroxine therapy in patients with thyroid disease. Data Sources: Relevant English language articles published from 1966 to 1...

Levothyroxine Therapy in Patients with Thyroid Disease

To review the indications for and the proper monitoring of levothyroxine therapy in patients with thyroid disease. Relevant English language articles published from 1966 to 1992 were identified through a MEDLINE search and manual searches of both identified articles and selected endocrinology texts. Studies, case reports, and review articles that contained data on the pathophysiologic aspects of relevant thyroid disorders and on the pharmacologic aspects of, indications for, and administration of levothyroxine therapy. Data on the epidemiology, clinical manifestations, complications, and treatment of thyroid disorders were analyzed with respect to patient selection, methods, diagnostic criteria, and conclusions. These data were used to develop a rational approach to the management of such patients. Levothyroxine is a reliable and commonly prescribed drug to treat thyroid disease, but excessive dosage may have adverse effects. In patients with hypothyroidism, levothyroxine is used as replacement therapy. For most patients, therapy can be initiated with a full replacement dosage (1.6 micrograms/kg body weight), which is usually 75 to 100 micrograms/day for women and 100 to 150 micrograms/d for men. The goal is to normalize the serum thyroid-stimulating hormone concentration. Levothyroxine is also used to suppress the serum thyroid-stimulating hormone concentration. A trial of thyroid-stimulating hormone suppressive therapy is indicated for most patients with benign solitary nonfunctioning thyroid nodules and for those with a history of thyroid cancer. Levothyroxine in non-thyroid-stimulating hormone-suppressive doses may also be indicated for patients with nontoxic multinodular goiter and for certain patients after lobectomy for benign thyroid nodules. With proper patient monitoring, levothyroxine replacement therapy should be effective, inexpensive, and free of complications. Recommendations for thyroid-stimulating hormone suppression with levothyroxine are based on risk-benefit considerations of the biologic characteristics of the thyroid disorder and the individual patient.

Lipoprotein and Apolipoprotein Levels in Subclinical Hypothyroidism

To assess whether subclinical hypothyroidism is associated with changes in lipoprotein fractions, 13 patients maintained in a stable state of subclinical hypothyroidism for at least 3 months were studied prior to and 2 and 4 months following restoration of a euthyroid state with incremental levothyroxine sodium therapy. Thyrotropin levels ( +/- SEM) had decreased from 16.6 +/- 3.2 mU/L to 3.1 +/- 0.7 mU/L and 3.2 +/- 0.7 mU/L at 2 months and 4 months. At 2 months, levothyroxine treatment led to a decrease in levels of total cholesterol from 5.5 +/- 0.3 mmol/L (213 +/- 12 mg/dL) to 4.8 +/- 0.3 mmol/L (186 +/- 12 mg/dL), in low-density lipoprotein cholesterol (LDL-C) from 3.7 +/- 0.3 mmol/L (143 +/- 12 mg/dL) to 2.9 +/- 0.3 mmol/L (112 +/- 12 mg/dL), and in apolipoprotein B from 91 +/- 8 mg/dL to 74 +/- 7 mg/dL. At 4 months, levels of LDL-C and apolipoprotein B remained significantly lower than pretreatment values (2.9 +/- 0.2 mmol/L [112 +/- 8 mg/dL] and 75 +/- 6 mg/dL, respectively). While high-density lipoprotein cholesterol (HDL-C), HDL3-C, and apolipoprotein A-I were not significantly affected by levothyroxine therapy, there was a slight trend of increase in HDL2-C during levothyroxine substitution. There was also a tendency for a decrease in triglyceride levels from 1.3 +/- 0.2 mmol/L (115 +/- 18 mg/dL) to 0.9 +/- 0.1 mmol/L (80 +/- 9 mg/dL) at 4 months of levothyroxine therapy. Levels of HDL-C tended to decrease from 4.8 +/- 0.4 mmol/L (186 +/- 15 mg/dL) to 4.5 +/- 0.5 mmol/L (174 +/- 19 mg/dL) at 2 months and to 3.9 +/- 0.4 mmol/L (151 +/- 15 mg/dL) at 4 months. The LDL-C/HDL-C ratio also decreased from 3.3 +/- 0.3 mmol/L (128 +/- 12 mg/dL) to 2.9 +/- 0.5 mmol/L (112 +/- 19 mg/dL) and 2.5 +/- 0.3 mmol/L (97 +/- 12 mg/dL) at 2 months and 4 months, respectively. These results suggest that long-term levothyroxine therapy in patients with subclinical hypothyroidism is associated with a decrease in LDL-C and apolipoprotein B levels that are reflected in a trend of decreases in cholesterol/HDL-C and LDL-C/HDL-C ratios known to have a relationship with coronary artery disease.