Appropriate Dose of Levothyroxine Replacement Therapy for Hypothyroid Obese Patients

Overview

Journal J Clin Transl Endocrinol

Specialty Endocrinology

Date 2021 Aug 17

PMID 34401353

Citations 4

Authors

Ganista Ratanapornsompong

Chutintorn Sriphrapradang

Affiliations

Soon will be listed here.

Abstract

Background: Athyreotic patients require a daily levothyroxine (LT4) doses of 1.6-1.8 mcg/kg of actual body weight (BW) to achieve normal thyroid stimulating hormone (TSH) levels. Lean body mass (LBM) calculation may be a more accurate determination of LT4 dose in obese patients. Previous studies were mainly investigated in Caucasians and LBM is markedly different between various ethnic groups. We aim to identify the optimal dose of LT4 replacement therapy in hypothyroid Thai patients including obese subjects.

Methods: We retrospectively reviewed the medical records of Thai adults with hypothyroidism at the thyroid clinic. Patients had been received LT4 (Brand: Euthyrox) at a stable dose ≥ 75 mcg/day for at least 1 year. Patients with thyroid cancer, pregnant, and lactating women were excluded. LBM was calculated by the Hume formula.

Results: Two hundred patients (80% females) with a mean age of 48.6 ± 14.8 years and a body mass index (BMI) of 24.5 ± 4.6 kg/m were included. Daily LT4 dose/kg of actual BW according to BMI 18.5-24.9, 25-29.9, and ≥ 30 kg/m were 1.67 ± 0.27, 1.51 ± 0.28 and 1.39 ± 0.34 mcg/kg, respectively. In contrast, LT4 dose/kg of LBM were 2.31 ± 0.39, 2.35 ± 0.45 and 2.36 ± 0.51 mcg/kg, respectively.

Conclusions: LBM is considered a better indicator for calculating an appropriate LT4 replacement dose than actual BW in hypothyroid obese Thai patients. The recommended daily dose of LT4 is 2.3 mcg/kg of LBM that could be applied for all ranges of BMI.

Citing Articles

Triiodothyronine/Thyroxine Ratio as a Marker of Clinical Response to Levothyroxine Replacement in Patients With Hypothyroidism.

Hadi Z, Alidrisi H, Mansour A Cureus. 2024; 16(4):e58370.

PMID: 38756268 PMC: 11097253. DOI: 10.7759/cureus.58370.

A Clinical Audit of Thyroid Hormonal Replacement After Total Thyroidectomy.

Mansy I, Elsenosy A, Hassan E, Zakria M Cureus. 2023; 15(12):e50374.

PMID: 38116025 PMC: 10730255. DOI: 10.7759/cureus.50374.

Levothyroxine therapy, calculated deiodinases activity and basal metabolic rate in obese or nonobese patients after total thyroidectomy for differentiated thyroid cancer, results of a retrospective observational study.

Le Moli R, Malandrino P, Russo M, Tumino D, Piticchio T, Naselli A Endocrinol Diabetes Metab. 2023; 6(2):e406.

PMID: 36722311 PMC: 10000637. DOI: 10.1002/edm2.406.

Profile of Levothyroxine Replacement Therapy in Graves' Disease Patients with Hypothyroidism Post-Radioactive Iodine Ablation: Focus on Different Weight-Based Regimens.

Mathiphanit S, Yenseung N, Chatchomchuan W, Butadej S, Nakasatien S, Wanothayaroj E J ASEAN Fed Endocr Soc. 2022; 37(1):62-68.

PMID: 35800593 PMC: 9242665. DOI: 10.15605/jafes.037.01.19.

References

Elfenbein D, Schaefer S, Shumway C, Chen H, Sippel R, Schneider D . Prospective Intervention of a Novel Levothyroxine Dosing Protocol Based on Body Mass Index after Thyroidectomy. J Am Coll Surg. 2015; 222(1):83-8. PMC: 4698011. DOI: 10.1016/j.jamcollsurg.2015.10.005. View

Fierabracci P, Martinelli S, Tamberi A, Piaggi P, Basolo A, Pelosini C . Weight Loss and Variation of Levothyroxine Requirements in Hypothyroid Obese Patients After Bariatric Surgery. Thyroid. 2016; 26(4):499-503. DOI: 10.1089/thy.2015.0473. View

Tan N, Chew R, Koh Y, Subramanian R, Sankari U, Meyappan M . Primary hypothyroidism in the community: Lower daily dosages of levothyroxine replacement therapy for Asian patients. Medicine (Baltimore). 2017; 96(7):e6145. PMC: 5319534. DOI: 10.1097/MD.0000000000006145. View

Van Der Spek A, Fliers E, Boelen A . The classic pathways of thyroid hormone metabolism. Mol Cell Endocrinol. 2017; 458:29-38. DOI: 10.1016/j.mce.2017.01.025. View

Santini F, Pinchera A, Marsili A, Ceccarini G, Castagna M, Valeriano R . Lean body mass is a major determinant of levothyroxine dosage in the treatment of thyroid diseases. J Clin Endocrinol Metab. 2004; 90(1):124-7. DOI: 10.1210/jc.2004-1306. View

Baehr K, Lyden E, Treude K, Erickson J, Goldner W . Levothyroxine dose following thyroidectomy is affected by more than just body weight. Laryngoscope. 2012; 122(4):834-8. DOI: 10.1002/lary.23186. View

Roos A, Linn-Rasker S, van Domburg R, Tijssen J, Berghout A . The starting dose of levothyroxine in primary hypothyroidism treatment: a prospective, randomized, double-blind trial. Arch Intern Med. 2005; 165(15):1714-20. DOI: 10.1001/archinte.165.15.1714. View

Santini F, Marzullo P, Rotondi M, Ceccarini G, Pagano L, Ippolito S . Mechanisms in endocrinology: the crosstalk between thyroid gland and adipose tissue: signal integration in health and disease. Eur J Endocrinol. 2014; 171(4):R137-52. DOI: 10.1530/EJE-14-0067. View

Arafah B . Increased need for thyroxine in women with hypothyroidism during estrogen therapy. N Engl J Med. 2001; 344(23):1743-9. DOI: 10.1056/NEJM200106073442302. View

10.

Shah A, Kandula N, Lin F, Allison M, Carr J, Herrington D . Less favorable body composition and adipokines in South Asians compared with other US ethnic groups: results from the MASALA and MESA studies. Int J Obes (Lond). 2015; 40(4):639-45. PMC: 4821815. DOI: 10.1038/ijo.2015.219. View

11.

Pan W, Yeh W . How to define obesity? Evidence-based multiple action points for public awareness, screening, and treatment: an extension of Asian-Pacific recommendations. Asia Pac J Clin Nutr. 2008; 17(3):370-4. View

12.

Cunningham J, BARZEL U . Lean body mass is a predictor of the daily requirement for thyroid hormone in older men and women. J Am Geriatr Soc. 1984; 32(3):204-7. DOI: 10.1111/j.1532-5415.1984.tb02003.x. View

13.

Xu X, Li W, Qin L, Yang W, Yu G, Wei Q . Relationship between Helicobacter pylori infection and obesity in Chinese adults: A systematic review with meta-analysis. PLoS One. 2019; 14(9):e0221076. PMC: 6738918. DOI: 10.1371/journal.pone.0221076. View

14.

Bartalena L, Martino E, Pacchiarotti A, Grasso L, Aghini-Lombardi F, Buratti L . Factors affecting suppression of endogenous thyrotropin secretion by thyroxine treatment: retrospective analysis in athyreotic and goitrous patients. J Clin Endocrinol Metab. 1987; 64(4):849-55. DOI: 10.1210/jcem-64-4-849. View

15.

Devdhar M, Drooger R, Pehlivanova M, Singh G, Jonklaas J . Levothyroxine replacement doses are affected by gender and weight, but not age. Thyroid. 2011; 21(8):821-7. PMC: 3148125. DOI: 10.1089/thy.2011.0029. View

16.

Pai M, PALOUCEK F . The origin of the "ideal" body weight equations. Ann Pharmacother. 2000; 34(9):1066-9. DOI: 10.1345/aph.19381. View

17.

Michalaki M, Gkotsina M, Mamali I, Markantes G, Faltaka A, Kalfarentzos F . Impaired pharmacokinetics of levothyroxine in severely obese volunteers. Thyroid. 2011; 21(5):477-81. DOI: 10.1089/thy.2010.0149. View

18.

Jin J, Allemang M, McHenry C . Levothyroxine replacement dosage determination after thyroidectomy. Am J Surg. 2013; 205(3):360-3. DOI: 10.1016/j.amjsurg.2012.10.015. View

19.

Xing J, Chen J . Alterations of gastrointestinal motility in obesity. Obes Res. 2004; 12(11):1723-32. DOI: 10.1038/oby.2004.213. View

20.

Rahman M, Berenson A . Racial difference in lean mass distribution among reproductive-aged women. Ethn Dis. 2011; 20(4):346-52. PMC: 3076634. View