Changes in TSH levels in athyreotic patients with differentiated thyroid cancer during levothyroxine therapy: influence on dose adjustments

摘要

Purpose The aim of the study was to describe the spontaneous TSH level variations and levothyroxine dose adjustments in athyreotic patients with differentiated thyroid cancer (DTC) in real-life practice. Methods Patients with DTC were retrospectively evaluated at a tertiary referral center between October 2006 and November 2013. Hormone measurements (TSH and FT4 serum levels), L-T4 prescription information (dose per kg per day) and other medications were recorded at 1 month and 3, 12, 24, 36 and 48 months after primary treatment (surgery +/- radioiodine therapy). Results The cohort was composed of 452 patients; about 20 of patients with stable levothyroxine dose have clinically meaningful spontaneous TSH variations (defined as Delta TSH > 2 mcUI/mL) at yearly follow-up visit. Furthermore, about 25 of athyreotic DTC patients with stable dose have a Delta TSH > 1.5 mcUI/mL and about 40 a Delta TSH > 1 mcUI/mL during each follow-up visit. We further investigated whether this TSH variation would lead to subsequent dose changes. About 19.9-37.7 of DTC patients on stable LT4 dose on the previous visit had their levothyroxine dose reduced, while 7.8-14.9 increased due to TSH variations. We further evaluated the decision to change the dose in relation with the age-specific TSH range. Up to 77.2 of patients had their dose adjusted due to TSH falling below the age-specific range. Conclusions Spontaneous serum TSH variations determine levothyroxine replacement therapy in athyreotic patients with DTC, requiring multiple dose changes.