Profile of Levothyroxine Replacement Therapy in Graves’ Disease Patients with Hypothyroidism Post-Radioactive Iodine Ablation

Focus on Different Weight-Based Regimens

Authors

  • Saravut Mathiphanit Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand https://orcid.org/0000-0001-8638-0910
  • Nalin Yenseung Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand
  • Waralee Chatchomchuan Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand https://orcid.org/0000-0003-0880-6693
  • Siriwan Butadej Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand
  • Soontaree Nakasatien Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand
  • Ekgaluck Wanothayaroj Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand
  • Rajata Rajatanavin Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand
  • Thep Himathongkam Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand
  • Yotsapon Thewjitcharoen Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand https://orcid.org/0000-0002-2317-4041

DOI:

https://doi.org/10.15605/jafes.037.01.19

Keywords:

post-ablative, hypothyroidism, Graves' disease, in-range TSH, levothyroxine (LT4), lean body mass

Abstract

Objective. To evaluate the status of euthyroidism achieved among Thai patients with post-ablative hypothyroidism and to examine the difference between various weight-based daily levothyroxine (LT4) replacement regimens in these patients.

Methodology. We conducted a retrospective review of Thai patients with Graves’ disease (GD) who developed hypothyroidism following radioactive iodine treatment from 2016  to 2020 at Theptarin hospital. Daily LT4 dose was calculated based on actual body weight (ABW), ideal body weight (IBW), and estimated lean body mass (LBM).

Results. We reviewed a total of 271 patient records. Of these, 81.2% were females with a mean age of 40.8±11.7 years, LT4 intake duration of 27.1±14.6 months, and LT4 dose/kg ABW of 1.4±0.5 μg/kg/day. At the final follow-up, 62.4% of patients achieved thyroid-stimulating hormone (TSH) levels within the reference interval, 15.5% had TSH levels over, and 22.1% had TSH levels under the reference range. Obese patients required a lower daily LT4 dose relative to ABW and higher daily LT4 dose relative to IBW to attain euthyroidism (ABW 1.1±0.4 μg/kg/day and IBW 2.0±0.8 μg/kg/day). Estimated daily LT4 dose based on LBM showed a constant dosage of 2.0 μg/kg/day in all BMI categories.  

Conclusions. Suboptimum LT4 replacement therapy was found in almost half of hypothyroid patients with GD treated with radioactive iodine. Estimated LBM was a better indicator for dosing calculation in these patients compared with ABW and IBW.

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Author Biographies

Saravut Mathiphanit, Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Pharmacist

Nalin Yenseung, Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Pharmacist

Waralee Chatchomchuan, Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Endocrinologist

Siriwan Butadej, Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Research Nurse

Ekgaluck Wanothayaroj, Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Endocrinologist

Rajata Rajatanavin, Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Endocrinologist

Thep Himathongkam, Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Endocrinologist

Yotsapon Thewjitcharoen, Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Endocrinologist

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Published

2022-05-07

How to Cite

Mathiphanit, S. ., Yenseung, N. ., Chatchomchuan, W., Butadej, S., Nakasatien, S., Wanothayaroj, E., Rajatanavin, R. ., Himathongkam, T., & Thewjitcharoen, Y. (2022). Profile of Levothyroxine Replacement Therapy in Graves’ Disease Patients with Hypothyroidism Post-Radioactive Iodine Ablation: Focus on Different Weight-Based Regimens. Journal of the ASEAN Federation of Endocrine Societies, 37(1), 62–68. https://doi.org/10.15605/jafes.037.01.19

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