S C Del Duca1, M G Santaguida1, N Brusca1, I Gatto1, M Cellini1, L Gargano1, C Verga Falzacappa1, F M Frattaroli1, C Virili1, M Centanni2. 1. Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Corso della Repubblica 79, 04100 Latina, ItalyDepartment of Surgical Specialties and Organ Transplantation 'P. Stefanini'Policlinico Umberto I, 'Sapienza' University of Rome, Rome, ItalyEndocrinology UnitAUSL Latina, Latina, Italy. 2. Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Corso della Repubblica 79, 04100 Latina, ItalyDepartment of Surgical Specialties and Organ Transplantation 'P. Stefanini'Policlinico Umberto I, 'Sapienza' University of Rome, Rome, ItalyEndocrinology UnitAUSL Latina, Latina, Italy Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Corso della Repubblica 79, 04100 Latina, ItalyDepartment of Surgical Specialties and Organ Transplantation 'P. Stefanini'Policlinico Umberto I, 'Sapienza' University of Rome, Rome, ItalyEndocrinology UnitAUSL Latina, Latina, Italy marco.centanni@uniroma1.it.
Abstract
OBJECTIVE: Thyroxine (T4) requirement after total thyroidectomy for differentiated thyroid carcinoma (DTC) is a debated issue. As most of the studies in the area have been retrospective and/or performed with heterogeneous therapeutic approaches, we designed our study to determine T4 requirement in the same patients and treatment settings, before and after total thyroidectomy. DESIGN, PATIENTS AND METHODS: This was a longitudinal study including 23 goitrous patients treated with T4 in an individually tailored fashion. All patients exhibited a stable TSH (median TSH = 0.28 mU/l) at a stable T4 dose for at least 1 year before surgery (median T4 dose = 1.50 μg/kg per day). The patients underwent total thyroidectomy based on cancer suspicion or compressive symptoms. Eventually diagnosed as having DTC (pT1b-pT2N0) and following surgical and radiometabolic treatment, they were treated with the same pre-surgical doses of T4. RESULTS: Three months after surgery,using the same pre-surgical dose, median TSH increased up to 5.38 mU/l (P<0.0001) and so the T4 dose had to be increased (median T4 dose = 1.95 μg/kg per day; +30%; P < 0.0001). Once divided by patients' age, we observed that, after thyroidectomy and maintaining the same pre-surgical dose, serum TSH significantly increased both in younger and in older patients (median TSH = 4.57 and 6.11 mU/l respectively). Serum TSH was restored to the pre-surgical level by increasing the dose up to 1.95 and 1.77 μg/kg per day (+25 and +21%) respectively. CONCLUSIONS: Following the same treatment regimen, a thyroidectomized patient requires one-third higher therapeutic T4 dose than before surgery. Despite this increase, the dose of T4 needed in our patients remains significantly lower than that previously described in athyreotic patients.
OBJECTIVE:Thyroxine (T4) requirement after total thyroidectomy for differentiated thyroid carcinoma (DTC) is a debated issue. As most of the studies in the area have been retrospective and/or performed with heterogeneous therapeutic approaches, we designed our study to determine T4 requirement in the same patients and treatment settings, before and after total thyroidectomy. DESIGN, PATIENTS AND METHODS: This was a longitudinal study including 23 goitrous patients treated with T4 in an individually tailored fashion. All patients exhibited a stable TSH (median TSH = 0.28 mU/l) at a stable T4 dose for at least 1 year before surgery (median T4 dose = 1.50 μg/kg per day). The patients underwent total thyroidectomy based on cancer suspicion or compressive symptoms. Eventually diagnosed as having DTC (pT1b-pT2N0) and following surgical and radiometabolic treatment, they were treated with the same pre-surgical doses of T4. RESULTS: Three months after surgery,using the same pre-surgical dose, median TSH increased up to 5.38 mU/l (P<0.0001) and so the T4 dose had to be increased (median T4 dose = 1.95 μg/kg per day; +30%; P < 0.0001). Once divided by patients' age, we observed that, after thyroidectomy and maintaining the same pre-surgical dose, serum TSH significantly increased both in younger and in older patients (median TSH = 4.57 and 6.11 mU/l respectively). Serum TSH was restored to the pre-surgical level by increasing the dose up to 1.95 and 1.77 μg/kg per day (+25 and +21%) respectively. CONCLUSIONS: Following the same treatment regimen, a thyroidectomized patient requires one-third higher therapeutic T4 dose than before surgery. Despite this increase, the dose of T4 needed in our patients remains significantly lower than that previously described in athyreoticpatients.
Authors: G Grani; D Tumino; V Ramundo; L Ciotti; C Lomonaco; M Armillotta; R Falcone; P Lucia; M Maranghi; S Filetti; C Durante Journal: J Endocrinol Invest Date: 2019-06-15 Impact factor: 4.256
Authors: R Bocale; A Barini; A D'Amore; M Boscherin; S Necozione; A Barini; G Desideri; C P Lombardi Journal: J Endocrinol Invest Date: 2020-10-14 Impact factor: 4.256