Levothyroxine replacement in primary congenital hypothyroidism: the higher the initial dose the higher the rate of overtreatment

被引:16
|
作者
Tuhan, Hale [1 ]
Abaci, Ayhan [1 ]
Cicek, Gizem [1 ]
Anik, Ahmet [1 ]
Catli, Gonul [1 ]
Demir, Korcan [1 ]
Bober, Ece [1 ]
机构
[1] Dokuz Eylul Univ, Dept Pediat Endocrinol, Fac Med, TR-35340 Izmir, Turkey
来源
JOURNAL OF PEDIATRIC ENDOCRINOLOGY & METABOLISM | 2016年 / 29卷 / 02期
关键词
congenital hypothyroidism; L-thyroxine; overtreatment; L-THYROXINE; CHILDREN; THERAPY; GROWTH;
D O I
10.1515/jpem-2015-0047
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Congenital hypothyroidism (CH) is the most frequent endocrine disorder during the neonatal period, and a delay in diagnosis and treatment leads to irreversible complications. A high L-thyroxine (LT4) dose is recommended for treatment, while the optimal starting dose is still a matter of debate. The objective of this study was to determine the effects of various starting doses of LT4 on serum thyroid stimulating hormone (TSH) and thyroxine (fT4) at the end of the first month of treatment. Methods: A total of 71 patients (37 males, 52.1%) with CH were included in the study. The patients were designated into three sets of subgroups according to the following categorical variables: (i) initial LT4 doses: 6-9.9 mu g/kg/day, 10-11.9 mu g/kg/day and 12-17 mu g/kg/day; (ii) initial TSH levels: 6-9.99 mu IU/mL, 10-75 mu IU/mL and >75 mu IU/mL; and (iii) etiology: dyshormonogenesis and dysgenesis. A fT4 level >2.3 ng/dL +/- a TSH level <0.5 mu IU/mL were considered as overtreatment. Results: The mean age of the study population was 22.3 +/- 13.2 days at diagnosis. At diagnosis, the mean fT4 was 0.84 +/- 0.32 ng/dL, and TSH was 39.3 +/- 30 mu IU/mL. The mean initial dose of LT4 was 10.9 +/- 2.9 mu g/kg/day. Overtreatment rates were significantly higher in the highest dose group (12-17 mu g/kg/day) compared with the lowest dose group (6-9.9 mu g/kg/day) (61.5% and 25%, respectively, p < 0.05). None of the patients was undertreated. Conclusions: In this study, we found that the rate of overtreatment was significantly higher in patients who were given LT4 doses of 12-17 mu g/kg/day. Thus, monitoring thyroid functions earlier than one month of treatment is necessary.
引用
收藏
页码:133 / 138
页数:6
相关论文
共 50 条
  • [1] LEVOTHYROXINE REPLACEMENT DOSE FOR PRIMARY HYPOTHYROIDISM DECREASES WITH AGE
    ROSENBAUM, RL
    BARZEL, US
    ANNALS OF INTERNAL MEDICINE, 1982, 96 (01) : 53 - 55
  • [2] EVALUATION OF TREATMENT OF CENTRAL HYPOTHYROIDISM VERSUS PRIMARY HYPOTHYROIDISM IN RELATION TO LEVOTHYROXINE REPLACEMENT DOSE
    Zeni, Debora
    Rissetti, Graziela
    Ongaratti, Barbara
    Pereira-Lima, Julia Fernanda
    Soares Leaes Rech, Carolina Garcia
    Oliveira, Miriam da Costa
    ENDOCRINE PRACTICE, 2019, 25 (07) : 663 - 668
  • [3] Effect of initial levothyroxine dose on neurodevelopmental and growth outcomes in children with congenital hypothyroidism
    Esposito, Andrea
    Vigone, Maria Cristina
    Polizzi, Miriam
    Wasniewska, Malgorzata Gabriela
    Cassio, Alessandra
    Mussa, Alessandro
    Gastaldi, Roberto
    Di Mase, Raffaella
    Vincenzi, Gaia
    Pozzi, Clara
    Peroni, Elena
    Bravaccio, Carmela
    Capalbo, Donatella
    Bruzzese, Dario
    Salerno, Mariacarolina
    FRONTIERS IN ENDOCRINOLOGY, 2022, 13
  • [4] Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults
    Philippe Caron
    Solange Grunenwald
    Luca Persani
    Françoise Borson-Chazot
    Remy Leroy
    Leonidas Duntas
    Reviews in Endocrine and Metabolic Disorders, 2022, 23 : 463 - 483
  • [5] Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults
    Caron, Philippe
    Grunenwald, Solange
    Persani, Luca
    Borson-Chazot, Francoise
    Leroy, Remy
    Duntas, Leonidas
    REVIEWS IN ENDOCRINE & METABOLIC DISORDERS, 2022, 23 (03): : 463 - 483
  • [6] Treatment of congenital hypothyroidism - impact of secular changes in levothyroxine initial dose on early growth
    Niuro, Laura
    Danner, Emmi
    Viikari, Liisa
    Kero, Jukka
    Huopio, Hanna
    Jaaskelainen, Jarmo
    Niinikoski, Harri
    HORMONE RESEARCH IN PAEDIATRICS, 2022, : 376 - 384
  • [7] Higher initial levothyroxine doses and very early treatment start may lead to better cognitive outcomes in children with congenital hypothyroidism
    Danner, Emmi
    Niuro, Laura
    Lapinoja, Sonja
    Huopio, Hanna
    Viikari, Liisa A.
    Kero, Jukka
    Jaaskelainen, Jarmo
    Niinikoski, Harri
    ACTA PAEDIATRICA, 2025, 114 (03) : 594 - 602
  • [8] HIGHER SENSITIVITY OF PRIMARY THYROTROPIN IN SCREENING FOR CONGENITAL HYPOTHYROIDISM - A MYTH
    DUSSAULT, JH
    MORISSETTE, J
    JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1983, 56 (04): : 849 - 852
  • [9] Levothyroxine Replacement Improves Oxidative Status in Primary Hypothyroidism
    Masullo, Lais Farias
    Magalhaes, Rejane Araujo
    Goncalves Lemes, Romelia Pinheiro
    de Almeida Filho, Tarcisio Paulo
    de Castro, Marilena Facundo
    Maia Filho, Pedro Aurio
    Vasconcelos Cunha, Taina Osterno
    Pinto Quidute, Ana Rosa
    Pereira Fontenele, Eveline Gadelha
    Sun, Guang
    Alves Martins, Manoel Ricardo
    FRONTIERS IN ENDOCRINOLOGY, 2018, 9
  • [10] High versus low dose of initial thyroid hormone replacement for congenital hypothyroidism
    Ng, Sze May
    Anand, Dhullipala
    Weindling, Alan M.
    COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2009, (01):