Thyroid hormone dose adjustments based on thyroid function tests

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Pharmacotherapy

Thyroid hormone dose adjustments based on thyroid function tests

11 October 2023

By Hilary Krebs

Wednesday 11 October 2023, 12:35 AM

T4 can be thought of as coffee beans, which are converted/ground to T3 as needed [Image: Ashkan Forouzani on Unsplash]

This article discusses the pitfalls in interpreting thyroid function tests when used to guide dose adjustments for thyroid hormone replacement

Key points, Thyroid-stimulating hormone levels alone should be used to guide levothyroxine dosing in almost all cases. Small adjustments in levothyroxine can ha, Pract Green w Pale Yellow

Investigations

References

Bornschein A, Paz-Filho G, Graf H, Carvalho GA. Treating primary hypothyroidism with weekly doses of levothyroxine: a randomized, single-blind, crossover study. Arq Bras Endocrinol Metabol 2012;56(4):250–58.
Duntas LH, Jonklaas J. Levothyroxine dose adjustment to optimise therapy throughout a patient’s lifetime. Adv Ther 2019;36(Suppl 2):30–46.
Dutta D, Jindal R, Kumar M, et al. Efficacy and safety of once weekly thyroxine as compared to daily thyroxine in managing primary hypothyroidism: A systematic review and meta-analysis. Indian J Endocrinol Metab 2021;25(2):76–85.
Jayakumari C, Nair A, Puthiyaveettil Khadar J, et al. Efficacy and safety of once-weekly thyroxine for thyroxine-resistant hypothyroidism. J Endocr Soc 2019;3(12):2184–93.
Jonklaas J, Bianco AC, Bauer AJ, et al. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid 2014;24(12):1670–751.
Koulouri O, Moran C, Halsall D, et al. Pitfalls in the measurement and interpretation of thyroid function tests. Best Pract Res Clin Endocrinol Metab 2013;27(6):745–62.
Ramadhan A, Tamilia M. Treatment-refractory hypothyroidism. CMAJ 2012;184(2):205–09.
The Royal College of Pathologists of Australasia. Position Statement: Thyroid Function Testing for Adult Diagnosis and Monitoring. 2017. https://www.rcpa.edu.au/Library/College-Policies/Position-Statements/Thyroid-Function-Testing-for-Adult-Diagnosis-and-M
Waring AC, Arnold AM, Newman AB, et al. Longitudinal changes in thyroid function in the oldest old and survival: the cardiovascular health study all-stars study. J Clin Endocrinol Metab 2012;97(11):3944–50.

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