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- Title
Individually-tailored thyroxine requirement in the same patients before and after thyroidectomy: a longitudinal study.
- Authors
Del Duca, S. C.; Santaguida, M. G.; Brusca, N.; Gatto, I.; Cellini, M.; Gargano, L.; Falzacappa, C. Verga; Frattaroli, F. M.; Virili, C.; Centanni, M.
- Abstract
Objective: Thyroxine (T4) requirement after total thyroidectomy for differentiated thyroid carcinoma (DTC) is a debated issue. As most of the studies in the area have been retrospective and/or performed with heterogeneous therapeutic approaches, we designed our study to determine T4 requirement in the same patients and treatment settings, before and after total thyroidectomy. Design, patients and methods: This was a longitudinal study including 23 goitrous patients treated with T4 in an individually tailored fashion. All patients exhibited a stable TSH (median TSH = 0.28 mU/l) at a stable T4 dose for at least 1 year before surgery (median T4 dose = 1.50 µg/kg per day). The patients underwent total thyroidectomy based on cancer suspicion or compressive symptoms. Eventually diagnosed as having DTC (pT1b-pT2N0) and following surgical and radiometabolic treatment, they were treated with the same pre-surgical doses of T4. Results: Three months after surgery, using the same pre-surgical dose, median TSH increased up to 5.38 mU/l (P<0.0001) and so the T4 dose had to be increased (median T4 dose=1.95 µg/kg per day; +30%; P<0.0001). Once divided by patients' age, we observed that, after thyroidectomy and maintaining the same pre-surgical dose, serum TSH significantly increased both in younger and in older patients (median TSH = 4.57 and 6.11 mU/l respectively). Serum TSH was restored to the pre-surgical level by increasing the dose up to 1.95 and 1.77 µg/kg per day (+25 and +21%) respectively. Conclusions: Following the same treatment regimen, a thyroidectomized patient requires one-third higher therapeutic T4 dose than before surgery. Despite this increase, the dose of T4 needed in our patients remains significantly lower than that previously described in athyreotic patients.
- Subjects
THYROXINE; THYROIDECTOMY; LONGITUDINAL method; THYROID cancer; GOITER
- Publication
European Journal of Endocrinology, 2015, Vol 173, Issue 3, p351
- ISSN
0804-4643
- Publication type
Article
- DOI
10.1530/EJE-15-0314