Thyroid Hormone Replacement in Total Thyroidectomized Patients: Symptomatic and Metabolic Effects of Levothyroxine Monotherapy

Purpose: In this study, we planned to investigate the effects of L-thyroxine monotherapy on total thyroidectomized patients. The main goal of our study is to evaluate if FT4 therapy is good enough not only to maintain euthyroidism but also to provide a good quality of life and a balance in their metabolism Methods: In this study, we retrospectively evaluated 30 total thyroidectomized patients without malignancy. We compared their thyroid hormone levels, glucose metabolism, lipid metabolism, their body mass indexes, and their symptoms of thyroid problems before surgery and after one year of treatment of L-thyroxine monotherapy. Results: the pre-op and post-op thyroid hormone levels were both in the normal range but the FT4 levels were significantly higher in the 1st year results than pre-op results (1,42 ± 0,18 vs 1,29 ± 0,49 respectively P=0,005*) The FT3 levels also were in the normal range in pre and 1st year post-op but post-op FT3 levels were significantly lower than pre-op levels (2,25 ± 0,27 vs 2,92 ± 0,49 retrospectively P

Keywords:

Thyroidectomy Lthyroxine, euthyroidi,

PDF

___

1). Perros P, Van Der Feltz-Cornelis C, Papini E, Nagy EV, Weetman AP, Hegedüs L. The Enigma Of Persistent Symptoms In Hypothyroid Patients Treated With Levothyroxine: A Narrative Review. Clin Endocrinol (Oxf). 2021 Mar 30. doi: 10.1111/cen.14473. [Epub ahead of print]
2). Jonklaas J, Bianco AC, Cappola AR, Celi FS, Fliers E, Heuer H, et al. Evidence-Based Use of Levothyroxine/Liothyronine Combinations in Treating Hypothyroidism: A Consensus Document. Eur Thyroid J. 2021 Mar; 10(1):10-38
3) Pirahanchi Y, Tariq MA, Jialal I. Physiology, Thyroid. 2021; Feb 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 30137850.
4). Mitsuru Ito, Akira Miyauchi, Mako Hisakado, Waka Yoshioka, Takumi Kudo, Eijun Nishihara, et al. Thyroid function related symptoms during levothyroxine monotherapy in athyreotic patients. Endocr J. 2019 Nov 28; 66(11):953-960.
5). Ito M, Miyauchi A, Hisakado M, Yoshioka W, Ide A, Kudo T, et al. Biochemical Markers Reflecting Thyroid Function in Athyreotic Patients on Levothyroxine Monotherapy. Thyroid 2017 Apr; 27(4):484-490.
6) Jonklaas J, Davidson B, Bhagat S, Soldin SJ. Triiodothyronine levels in athyreotic individuals during levothyroxine therapy. JAMA 2008; 20; 299(7):769-77.
7). Wolska A, Remaley AT. Measuring LDL-cholesterol: what is the best way to do it? Curr Opin Cardiol. 2020; 35(4):405-411.
8) Billewicz WZ, Chapman RS, Crooks J, Day ME, Gossage J, et al. Statistical methods applied to the diagnosis of hypothyroidism. Q J Med 1969; 38: 255–266.
9). Zulewski H, Müller B, Exer P, Miserez AR, Staub JJ. Estimation of tissue hypothyroidism by a new clinical score: evaluation of patients with various grades of hypothyroidism and controls. J Clin Endocrinol Metab 1997; 82: 771–776.
10) Klein I, Trzepacz PT, Roberts M, Levey GS Symptom rating scale for assessing hyperthyroidism. Arch Intern Med 1988; 148: 387–390.
11). Ettleson MD, Bianco AC. Individualized Therapy for Hypothyroidism: Is T4 Enough for Everyone? J Clin Endocrinol Metab. 2020; 105(9) :e3090–104.
12) Ross JS, Rohde S, Sangaralingham L, Brito JP, Choi L, Dutcher SK, et all. Generic and Brand-Name Thyroid Hormone Drug Use Among Commercially Insured and Medicare Beneficiaries, 2007 Through 2016. J. Clin. Endocrinol. Metab. 2019; 104(6):2305–2314.
13) Mitchell AL, Hickey B, Hickey JL, Pearce SHS. Trends in thyroid hormone prescribing and consumption in the UK. BMC Public Health 2009; 9 :132.
14) Sawin CT, Herman T, Molitch ME, London MH, Kramer SM. Aging and the thyroid. Decreased requirement for thyroid hormone in older hypothyroid patients. Am. J. Med.1983; 75 (2): 206–209.
15). Kahn A. Serum triiodothyronine levels in patients receiving L-thyroxine. ClinicalPharmacology & Therapeutics 1976; 19(part1): 523–530.
16) Gullo D, Latina A, Frasca F, Le Moli R, Pellegriti G, Vigneri R. Levothyroxine monotherapy cannot guarantee euthyroidism in all athyreotic patients. PLoS One 2011; 6(8): 225-52.
17) Jennings PE, O’Malley BP, Griffin KE, Northover B, Rosenthal FD. Relevance of increased serum thyroxine concentrations associated with normal serum triiodothyronine values in hypothyroid patients receiving thyroxine: a case for “tissue thyrotoxicosis.” BMJ 1984; 289 (6459): 1645-1647.
18). Samuels MH, Schuff KG, Carlson NE, Carello P, Janowsky JS. Health status, psychological symptoms, mood, and cognition in L-thyroxine-treated hypothyroid subjects. Thyroid 2007; 17(3): 249–258.
19). Jonklaas J, Davidson B, Bhagat S, Soldin SJ. Triiodothyronine levels in athyreotic individuals during levothyroxine therapy. JAMA 2008; 299(7) :769–777.
20). Ridgway EC, Cooper DS, Walker H, Daniels GH, Chin WW, Myers G, Maloof F. Therapy of primary hypothyroidism with l-triiodothyronine: Discordant cardiac and pituitary responses. Clinical endocrinology 1980; 13(5): 479–488.
21) Štěpánek L, Horáková D, Štěpánek L, Janout V, Janoutová J, Bouchalová K, et al. Free triiodothyronine/free thyroxine (FT3/FT4) ratio is strongly associated with insulin resistance in euthyroid and hypothyroid adults: a cross-sectional study. Endokrynol Pol. 2021; 72(1): 8-13.
22). Larisch R, Midgley JEM, Dietrich JW, Hoermann R. Symptomatic relief is related to serum free triiodothyronine concentrations during follow-up in levothyroxine-treated patients with differentiated thyroid cancer. Exp Clin Endocrinol Diabetes 2018; 126: 546–552.
23) Hirata Y, Fukuoka H, Iguchi G, Iwahashi Y, Fujita Y, et al. Median-lower normal levels of serum thyroxine are associated with low triiodothyronine levels and body temperature in patients with central hypothyroidism. Eur J Endocrinol 2015; 173: 247–256.
24) Wellwood C, Rardin S. Adrenal and Thyroid Supplementation Outperforms Nutritional Supplementation and Medications for Autoimmune Thyroiditis. Integr Med 2014 Jun; 13(3): 41-7.
25) Borson-Chazot F, Terra JL, Goichot B, Caron P. What Is the Quality of Life in Patients Treated with Levothyroxine for Hypothyroidism and How Are We Measuring It? A Critical Narrative Review. J Clin Med. 2021 Mar 30; 10(7): 1386.