Changes in TSH levels in athyreotic patients with differentiated thyroid cancer during levothyroxine therapy: influence on dose adjustments
Purpose The aim of the study was to describe the spontaneous TSH level variations and levothyroxine dose adjustments in athyreotic patients with differentiated thyroid cancer (DTC) in real-life practice. Methods Patients with DTC were retrospectively evaluated at a tertiary referral center between O...
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| Veröffentlicht in: | Journal of endocrinological investigation 2019-12, Vol.42 (12), p.1485-1490 |
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| container_title | Journal of endocrinological investigation |
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| creator | Grani, G. Tumino, D. Ramundo, V. Ciotti, L. Lomonaco, C. Armillotta, M. Falcone, R. Lucia, P. Maranghi, M. Filetti, S. Durante, C. |
| description | Purpose
The aim of the study was to describe the spontaneous TSH level variations and levothyroxine dose adjustments in athyreotic patients with differentiated thyroid cancer (DTC) in real-life practice.
Methods
Patients with DTC were retrospectively evaluated at a tertiary referral center between October 2006 and November 2013. Hormone measurements (TSH and FT4 serum levels), L-T4 prescription information (dose per kg per day) and other medications were recorded at 1 month and 3, 12, 24, 36 and 48 months after primary treatment (surgery ± radioiodine therapy).
Results
The cohort was composed of 452 patients; about 20% of patients with stable levothyroxine dose have clinically meaningful spontaneous TSH variations (defined as ΔTSH > 2 mcUI/mL) at yearly follow-up visit. Furthermore, about 25% of athyreotic DTC patients with stable dose have a ΔTSH > 1.5 mcUI/mL and about 40% a ΔTSH > 1 mcUI/mL during each follow-up visit. We further investigated whether this TSH variation would lead to subsequent dose changes. About 19.9–37.7% of DTC patients on stable LT4 dose on the previous visit had their levothyroxine dose reduced, while 7.8–14.9% increased due to TSH variations. We further evaluated the decision to change the dose in relation with the age-specific TSH range. Up to 77.2% of patients had their dose adjusted due to TSH falling below the age-specific range.
Conclusions
Spontaneous serum TSH variations determine levothyroxine replacement therapy in athyreotic patients with DTC, requiring multiple dose changes. |
| doi_str_mv | 10.1007/s40618-019-01074-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2242158381</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2312577644</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-7afa5271f10e6240ff7a845cd8887124035dc06aeee99084e9a42760481fa7203</originalsourceid><addsrcrecordid>eNp9kcuOFCEUhonROBd9AReGxI2bUm5VUO5MR2dMJpnFjGuCxWGaTjWUQGn3M_jSUt3jJbOYBYED3_kP-X-EXlHyjhIi32dBOqoaQvu6iBTN7gk6pZKRRnHVPf3vfILOct4QwiVX8jk64ZQRLnp5in6t1ibcQcY-4NubSzzCDxgPlSnrfYJY_IAnUzyEkvFPX9bYeucg1dqbAhYvWPQWDyYMkLCdkw93i048vOx8gMpAMtP-Q9V14wwVxDFgGzNgYzdzLttF_gV65syY4eX9fo6-fv50u7psrq4vvqw-XjUDl21ppHGmZZI6SqBjgjgnjRLtYJVSktYL3tqBdAYA-p4oAb0RTHZEKOpMdYSfo7dH3SnF7zPkorc-DzCOJkCcs2ZMMNpW32hF3zxAN3FOof5Os2piK2UnRKXYkRpSzDmB01PyW5P2mhK9RKWPUekalT5EpXe16fW99PxtC_Zvy59sKsCPQJ4WSyH9m_2I7G84N6Fe</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2312577644</pqid></control><display><type>article</type><title>Changes in TSH levels in athyreotic patients with differentiated thyroid cancer during levothyroxine therapy: influence on dose adjustments</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Grani, G. ; Tumino, D. ; Ramundo, V. ; Ciotti, L. ; Lomonaco, C. ; Armillotta, M. ; Falcone, R. ; Lucia, P. ; Maranghi, M. ; Filetti, S. ; Durante, C.</creator><creatorcontrib>Grani, G. ; Tumino, D. ; Ramundo, V. ; Ciotti, L. ; Lomonaco, C. ; Armillotta, M. ; Falcone, R. ; Lucia, P. ; Maranghi, M. ; Filetti, S. ; Durante, C.</creatorcontrib><description>Purpose
The aim of the study was to describe the spontaneous TSH level variations and levothyroxine dose adjustments in athyreotic patients with differentiated thyroid cancer (DTC) in real-life practice.
Methods
Patients with DTC were retrospectively evaluated at a tertiary referral center between October 2006 and November 2013. Hormone measurements (TSH and FT4 serum levels), L-T4 prescription information (dose per kg per day) and other medications were recorded at 1 month and 3, 12, 24, 36 and 48 months after primary treatment (surgery ± radioiodine therapy).
Results
The cohort was composed of 452 patients; about 20% of patients with stable levothyroxine dose have clinically meaningful spontaneous TSH variations (defined as ΔTSH > 2 mcUI/mL) at yearly follow-up visit. Furthermore, about 25% of athyreotic DTC patients with stable dose have a ΔTSH > 1.5 mcUI/mL and about 40% a ΔTSH > 1 mcUI/mL during each follow-up visit. We further investigated whether this TSH variation would lead to subsequent dose changes. About 19.9–37.7% of DTC patients on stable LT4 dose on the previous visit had their levothyroxine dose reduced, while 7.8–14.9% increased due to TSH variations. We further evaluated the decision to change the dose in relation with the age-specific TSH range. Up to 77.2% of patients had their dose adjusted due to TSH falling below the age-specific range.
Conclusions
Spontaneous serum TSH variations determine levothyroxine replacement therapy in athyreotic patients with DTC, requiring multiple dose changes.</description><identifier>ISSN: 1720-8386</identifier><identifier>ISSN: 0391-4097</identifier><identifier>EISSN: 1720-8386</identifier><identifier>DOI: 10.1007/s40618-019-01074-x</identifier><identifier>PMID: 31203497</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adult ; Dose-Response Relationship, Drug ; Endocrinology ; Female ; Hormone Replacement Therapy ; Humans ; Internal Medicine ; Iodine Radioisotopes - therapeutic use ; Male ; Medicine ; Medicine & Public Health ; Metabolic Diseases ; Middle Aged ; Original Article ; Patients ; Retrospective Studies ; Serum levels ; Surgery ; Thyroid cancer ; Thyroid Neoplasms - blood ; Thyroid Neoplasms - drug therapy ; Thyroid Neoplasms - radiotherapy ; Thyroid Neoplasms - surgery ; Thyroid-stimulating hormone ; Thyroidectomy ; Thyrotropin - blood ; Thyroxine ; Thyroxine - administration & dosage ; Thyroxine - blood ; Thyroxine - therapeutic use ; Variation</subject><ispartof>Journal of endocrinological investigation, 2019-12, Vol.42 (12), p.1485-1490</ispartof><rights>Italian Society of Endocrinology (SIE) 2019</rights><rights>Copyright Springer Nature B.V. 2019</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-7afa5271f10e6240ff7a845cd8887124035dc06aeee99084e9a42760481fa7203</citedby><cites>FETCH-LOGICAL-c375t-7afa5271f10e6240ff7a845cd8887124035dc06aeee99084e9a42760481fa7203</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s40618-019-01074-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s40618-019-01074-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,782,786,27931,27932,41495,42564,51326</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31203497$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Grani, G.</creatorcontrib><creatorcontrib>Tumino, D.</creatorcontrib><creatorcontrib>Ramundo, V.</creatorcontrib><creatorcontrib>Ciotti, L.</creatorcontrib><creatorcontrib>Lomonaco, C.</creatorcontrib><creatorcontrib>Armillotta, M.</creatorcontrib><creatorcontrib>Falcone, R.</creatorcontrib><creatorcontrib>Lucia, P.</creatorcontrib><creatorcontrib>Maranghi, M.</creatorcontrib><creatorcontrib>Filetti, S.</creatorcontrib><creatorcontrib>Durante, C.</creatorcontrib><title>Changes in TSH levels in athyreotic patients with differentiated thyroid cancer during levothyroxine therapy: influence on dose adjustments</title><title>Journal of endocrinological investigation</title><addtitle>J Endocrinol Invest</addtitle><addtitle>J Endocrinol Invest</addtitle><description>Purpose
The aim of the study was to describe the spontaneous TSH level variations and levothyroxine dose adjustments in athyreotic patients with differentiated thyroid cancer (DTC) in real-life practice.
Methods
Patients with DTC were retrospectively evaluated at a tertiary referral center between October 2006 and November 2013. Hormone measurements (TSH and FT4 serum levels), L-T4 prescription information (dose per kg per day) and other medications were recorded at 1 month and 3, 12, 24, 36 and 48 months after primary treatment (surgery ± radioiodine therapy).
Results
The cohort was composed of 452 patients; about 20% of patients with stable levothyroxine dose have clinically meaningful spontaneous TSH variations (defined as ΔTSH > 2 mcUI/mL) at yearly follow-up visit. Furthermore, about 25% of athyreotic DTC patients with stable dose have a ΔTSH > 1.5 mcUI/mL and about 40% a ΔTSH > 1 mcUI/mL during each follow-up visit. We further investigated whether this TSH variation would lead to subsequent dose changes. About 19.9–37.7% of DTC patients on stable LT4 dose on the previous visit had their levothyroxine dose reduced, while 7.8–14.9% increased due to TSH variations. We further evaluated the decision to change the dose in relation with the age-specific TSH range. Up to 77.2% of patients had their dose adjusted due to TSH falling below the age-specific range.
Conclusions
Spontaneous serum TSH variations determine levothyroxine replacement therapy in athyreotic patients with DTC, requiring multiple dose changes.</description><subject>Adult</subject><subject>Dose-Response Relationship, Drug</subject><subject>Endocrinology</subject><subject>Female</subject><subject>Hormone Replacement Therapy</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Iodine Radioisotopes - therapeutic use</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metabolic Diseases</subject><subject>Middle Aged</subject><subject>Original Article</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Serum levels</subject><subject>Surgery</subject><subject>Thyroid cancer</subject><subject>Thyroid Neoplasms - blood</subject><subject>Thyroid Neoplasms - drug therapy</subject><subject>Thyroid Neoplasms - radiotherapy</subject><subject>Thyroid Neoplasms - surgery</subject><subject>Thyroid-stimulating hormone</subject><subject>Thyroidectomy</subject><subject>Thyrotropin - blood</subject><subject>Thyroxine</subject><subject>Thyroxine - administration & dosage</subject><subject>Thyroxine - blood</subject><subject>Thyroxine - therapeutic use</subject><subject>Variation</subject><issn>1720-8386</issn><issn>0391-4097</issn><issn>1720-8386</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcuOFCEUhonROBd9AReGxI2bUm5VUO5MR2dMJpnFjGuCxWGaTjWUQGn3M_jSUt3jJbOYBYED3_kP-X-EXlHyjhIi32dBOqoaQvu6iBTN7gk6pZKRRnHVPf3vfILOct4QwiVX8jk64ZQRLnp5in6t1ibcQcY-4NubSzzCDxgPlSnrfYJY_IAnUzyEkvFPX9bYeucg1dqbAhYvWPQWDyYMkLCdkw93i048vOx8gMpAMtP-Q9V14wwVxDFgGzNgYzdzLttF_gV65syY4eX9fo6-fv50u7psrq4vvqw-XjUDl21ppHGmZZI6SqBjgjgnjRLtYJVSktYL3tqBdAYA-p4oAb0RTHZEKOpMdYSfo7dH3SnF7zPkorc-DzCOJkCcs2ZMMNpW32hF3zxAN3FOof5Os2piK2UnRKXYkRpSzDmB01PyW5P2mhK9RKWPUekalT5EpXe16fW99PxtC_Zvy59sKsCPQJ4WSyH9m_2I7G84N6Fe</recordid><startdate>20191201</startdate><enddate>20191201</enddate><creator>Grani, G.</creator><creator>Tumino, D.</creator><creator>Ramundo, V.</creator><creator>Ciotti, L.</creator><creator>Lomonaco, C.</creator><creator>Armillotta, M.</creator><creator>Falcone, R.</creator><creator>Lucia, P.</creator><creator>Maranghi, M.</creator><creator>Filetti, S.</creator><creator>Durante, C.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20191201</creationdate><title>Changes in TSH levels in athyreotic patients with differentiated thyroid cancer during levothyroxine therapy: influence on dose adjustments</title><author>Grani, G. ; Tumino, D. ; Ramundo, V. ; Ciotti, L. ; Lomonaco, C. ; Armillotta, M. ; Falcone, R. ; Lucia, P. ; Maranghi, M. ; Filetti, S. ; Durante, C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-7afa5271f10e6240ff7a845cd8887124035dc06aeee99084e9a42760481fa7203</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Dose-Response Relationship, Drug</topic><topic>Endocrinology</topic><topic>Female</topic><topic>Hormone Replacement Therapy</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Iodine Radioisotopes - therapeutic use</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metabolic Diseases</topic><topic>Middle Aged</topic><topic>Original Article</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Serum levels</topic><topic>Surgery</topic><topic>Thyroid cancer</topic><topic>Thyroid Neoplasms - blood</topic><topic>Thyroid Neoplasms - drug therapy</topic><topic>Thyroid Neoplasms - radiotherapy</topic><topic>Thyroid Neoplasms - surgery</topic><topic>Thyroid-stimulating hormone</topic><topic>Thyroidectomy</topic><topic>Thyrotropin - blood</topic><topic>Thyroxine</topic><topic>Thyroxine - administration & dosage</topic><topic>Thyroxine - blood</topic><topic>Thyroxine - therapeutic use</topic><topic>Variation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Grani, G.</creatorcontrib><creatorcontrib>Tumino, D.</creatorcontrib><creatorcontrib>Ramundo, V.</creatorcontrib><creatorcontrib>Ciotti, L.</creatorcontrib><creatorcontrib>Lomonaco, C.</creatorcontrib><creatorcontrib>Armillotta, M.</creatorcontrib><creatorcontrib>Falcone, R.</creatorcontrib><creatorcontrib>Lucia, P.</creatorcontrib><creatorcontrib>Maranghi, M.</creatorcontrib><creatorcontrib>Filetti, S.</creatorcontrib><creatorcontrib>Durante, C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of endocrinological investigation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Grani, G.</au><au>Tumino, D.</au><au>Ramundo, V.</au><au>Ciotti, L.</au><au>Lomonaco, C.</au><au>Armillotta, M.</au><au>Falcone, R.</au><au>Lucia, P.</au><au>Maranghi, M.</au><au>Filetti, S.</au><au>Durante, C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Changes in TSH levels in athyreotic patients with differentiated thyroid cancer during levothyroxine therapy: influence on dose adjustments</atitle><jtitle>Journal of endocrinological investigation</jtitle><stitle>J Endocrinol Invest</stitle><addtitle>J Endocrinol Invest</addtitle><date>2019-12-01</date><risdate>2019</risdate><volume>42</volume><issue>12</issue><spage>1485</spage><epage>1490</epage><pages>1485-1490</pages><issn>1720-8386</issn><issn>0391-4097</issn><eissn>1720-8386</eissn><abstract>Purpose
The aim of the study was to describe the spontaneous TSH level variations and levothyroxine dose adjustments in athyreotic patients with differentiated thyroid cancer (DTC) in real-life practice.
Methods
Patients with DTC were retrospectively evaluated at a tertiary referral center between October 2006 and November 2013. Hormone measurements (TSH and FT4 serum levels), L-T4 prescription information (dose per kg per day) and other medications were recorded at 1 month and 3, 12, 24, 36 and 48 months after primary treatment (surgery ± radioiodine therapy).
Results
The cohort was composed of 452 patients; about 20% of patients with stable levothyroxine dose have clinically meaningful spontaneous TSH variations (defined as ΔTSH > 2 mcUI/mL) at yearly follow-up visit. Furthermore, about 25% of athyreotic DTC patients with stable dose have a ΔTSH > 1.5 mcUI/mL and about 40% a ΔTSH > 1 mcUI/mL during each follow-up visit. We further investigated whether this TSH variation would lead to subsequent dose changes. About 19.9–37.7% of DTC patients on stable LT4 dose on the previous visit had their levothyroxine dose reduced, while 7.8–14.9% increased due to TSH variations. We further evaluated the decision to change the dose in relation with the age-specific TSH range. Up to 77.2% of patients had their dose adjusted due to TSH falling below the age-specific range.
Conclusions
Spontaneous serum TSH variations determine levothyroxine replacement therapy in athyreotic patients with DTC, requiring multiple dose changes.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>31203497</pmid><doi>10.1007/s40618-019-01074-x</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Dose-Response Relationship, Drug Endocrinology Female Hormone Replacement Therapy Humans Internal Medicine Iodine Radioisotopes - therapeutic use Male Medicine Medicine & Public Health Metabolic Diseases Middle Aged Original Article Patients Retrospective Studies Serum levels Surgery Thyroid cancer Thyroid Neoplasms - blood Thyroid Neoplasms - drug therapy Thyroid Neoplasms - radiotherapy Thyroid Neoplasms - surgery Thyroid-stimulating hormone Thyroidectomy Thyrotropin - blood Thyroxine Thyroxine - administration & dosage Thyroxine - blood Thyroxine - therapeutic use Variation |
| title | Changes in TSH levels in athyreotic patients with differentiated thyroid cancer during levothyroxine therapy: influence on dose adjustments |
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