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Horm Metab Res 2014; 46(11): 794-799
DOI: 10.1055/s-0034-1375678
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

The Thyroid Axis ‘Setpoints’ are Significantly Altered After Long-Term Suppressive LT4 Therapy

F. A. Verburg
1   Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
2   Department of Nuclear Medicine, RWTH Aachen University Hospital, Aachen, Germany
,
U. Mäder
3   Comprehensive Cancer Center, University of Würzburg, Würzburg, Germany
,
I. Grelle
1   Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
,
T. J. Visser
4   Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
,
R. P. Peeters
4   Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
,
J. W. A. Smit
5   Department of Internal Medicine, University Medical Center St. Radboud, Nijmegen, The Netherlands
,
C. Reiners
1   Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
› Author Affiliations
Further Information

Publication History

received 17 February 2014

accepted 24 April 2014

Publication Date:
27 May 2014 (online)

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Abstract

The aim of the study was to investigate the changes in the thyroid axis setpoint after long-term suppressive levothyroxine therapy for differentiated thyroid carcinoma and the resulting changes in levothyroxine requirement. Ninety-nine differentiated thyroid cancer patients were reviewed. All patients had at least one known TSH-level≥0.01 mU/l (lower detection limit) and <1.0 mU/l within 2 years of initial treatment (time 1) and had at least one TSH-value≥0.01 mU/l and <1.0 mU/l after continuous LT4 therapy for a minimum of 5 years (time 2).

At time 2 the mean LT4 dosage/kg body weight, TSH, FT3, and FT4 levels were significantly lower than at time 1, while body weight was higher. At time 2, the FT3/FT4 ratio rate had dropped significantly (p<0.001). At time 1, patients would require 2.96 μg/kg body weight to reach total TSH suppression. The dose of levothyroxine/kg required for suppression can be lowered by about 0.05 μg/kg body weight for each year of suppressive therapy. After a median of 12.7 years of continuous suppressive levothyroxine therapy, patients would require 2.25 μg/kg body weight (−23.5%) to reach total TSH-suppression. At least part of this reduction was independent of aging. As a result of changes in thyroid hormone metabolism and thyroid axis setpoint, long-term TSH-suppressive therapy contributes to a reduction in the dosage of levothyroxine per kilogram body weight required for full TSH suppression over time.

Key words

thyroid cancer - TSH suppression - levothyroxine - pituitary
 

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