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The different requirement of L-T4 therapy in congenital athyreosis compared with adult-acquired hypothyroidism suggests a persisting thyroid hormone resistance at the hypothalamic-pituitary level.
Eur J Endocrinol 2014; 171(5):615-21EJ

Abstract

BACKGROUND

Levothyroxine (l-T4) is commonly employed to correct hormone deficiency in children with congenital hypothyroidism (CH) and in adult patients with iatrogenic hypothyroidism.

OBJECTIVE

To compare the daily weight-based dosage of the replacement therapy with l-T4 in athyreotic adult patients affected by CH and adult patients with thyroid nodular or cancer diseases treated by total thyroidectomy.

DESIGN AND METHODS

A total of 36 adult patients (27 females and nine males) aged 18-29 years were studied; 13 patients (age: 21.5±2.1, group CH) had athyreotic CH treated with l-T4 since the first days of life. The remaining 23 patients (age: 24±2.7, group AH) had hypothyroidism after total thyroidectomy (14 patients previously affected by nodular disease and nine by thyroid carcinoma with clinical and biochemical remission). Patient weight, serum free thyroid hormones, TSH, thyroglobulin (Tg), anti-Tg, and anti-thyroperoxidase antibodies were measured. Required l-T4 dosage was evaluated. At the time of the observations, all patients presented free thyroid hormones within the normal range and TSH between 0.8 and 2 μIU/ml.

RESULTS

Patients had undetectable Tg and anti-thyroid antibodies. The daily weight-based dosage of the replacement therapy with l-T4 to reach euthyroidism in patients of group CH was significantly higher than that in those of group AH (2.16±0.36 vs 1.73±0.24 μg/kg, P<0.005). Patients of group CH treated with l-T4 had significantly higher serum TSH levels than patients of group AH (P=0.05) as well as higher FT4 concentrations.

CONCLUSIONS

To correct hypothyroidism, patients of group CH required a daily l-T4 dose/kg higher than group AH patients, despite higher levels of TSH. The different requirement of replacement therapy between adult patients with congenital and those with surgical athyroidism could be explained by a lack of thyroid hormones since fetal life in CH, which could determine a different set point of the hypothalamus-pituitary-thyroid axis.

Authors+Show Affiliations

Endocrinology SectionDepartment of Clinical and Experimental Medicine, University Hospital of Pisa, University of Pisa, Via Paradisa 2, Cisanello, Pisa 56124, Italy.Endocrinology SectionDepartment of Clinical and Experimental Medicine, University Hospital of Pisa, University of Pisa, Via Paradisa 2, Cisanello, Pisa 56124, Italy.Endocrinology SectionDepartment of Clinical and Experimental Medicine, University Hospital of Pisa, University of Pisa, Via Paradisa 2, Cisanello, Pisa 56124, Italy.Endocrinology SectionDepartment of Clinical and Experimental Medicine, University Hospital of Pisa, University of Pisa, Via Paradisa 2, Cisanello, Pisa 56124, Italy.Endocrinology SectionDepartment of Clinical and Experimental Medicine, University Hospital of Pisa, University of Pisa, Via Paradisa 2, Cisanello, Pisa 56124, Italy.Endocrinology SectionDepartment of Clinical and Experimental Medicine, University Hospital of Pisa, University of Pisa, Via Paradisa 2, Cisanello, Pisa 56124, Italy.Endocrinology SectionDepartment of Clinical and Experimental Medicine, University Hospital of Pisa, University of Pisa, Via Paradisa 2, Cisanello, Pisa 56124, Italy.Endocrinology SectionDepartment of Clinical and Experimental Medicine, University Hospital of Pisa, University of Pisa, Via Paradisa 2, Cisanello, Pisa 56124, Italy.Endocrinology SectionDepartment of Clinical and Experimental Medicine, University Hospital of Pisa, University of Pisa, Via Paradisa 2, Cisanello, Pisa 56124, Italy mtonacchera@hotmail.com.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

25305309

Citation

Bagattini, Brunella, et al. "The Different Requirement of L-T4 Therapy in Congenital Athyreosis Compared With Adult-acquired Hypothyroidism Suggests a Persisting Thyroid Hormone Resistance at the Hypothalamic-pituitary Level." European Journal of Endocrinology, vol. 171, no. 5, 2014, pp. 615-21.
Bagattini B, Cosmo CD, Montanelli L, et al. The different requirement of L-T4 therapy in congenital athyreosis compared with adult-acquired hypothyroidism suggests a persisting thyroid hormone resistance at the hypothalamic-pituitary level. Eur J Endocrinol. 2014;171(5):615-21.
Bagattini, B., Cosmo, C. D., Montanelli, L., Piaggi, P., Ciampi, M., Agretti, P., ... Tonacchera, M. (2014). The different requirement of L-T4 therapy in congenital athyreosis compared with adult-acquired hypothyroidism suggests a persisting thyroid hormone resistance at the hypothalamic-pituitary level. European Journal of Endocrinology, 171(5), pp. 615-21. doi:10.1530/EJE-14-0621.
Bagattini B, et al. The Different Requirement of L-T4 Therapy in Congenital Athyreosis Compared With Adult-acquired Hypothyroidism Suggests a Persisting Thyroid Hormone Resistance at the Hypothalamic-pituitary Level. Eur J Endocrinol. 2014;171(5):615-21. PubMed PMID: 25305309.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The different requirement of L-T4 therapy in congenital athyreosis compared with adult-acquired hypothyroidism suggests a persisting thyroid hormone resistance at the hypothalamic-pituitary level. AU - Bagattini,Brunella, AU - Cosmo,Caterina Di, AU - Montanelli,Lucia, AU - Piaggi,Paolo, AU - Ciampi,Mariella, AU - Agretti,Patrizia, AU - Marco,Giuseppina De, AU - Vitti,Paolo, AU - Tonacchera,Massimo, PY - 2014/10/12/entrez PY - 2014/10/12/pubmed PY - 2015/1/8/medline SP - 615 EP - 21 JF - European journal of endocrinology JO - Eur. J. Endocrinol. VL - 171 IS - 5 N2 - BACKGROUND: Levothyroxine (l-T4) is commonly employed to correct hormone deficiency in children with congenital hypothyroidism (CH) and in adult patients with iatrogenic hypothyroidism. OBJECTIVE: To compare the daily weight-based dosage of the replacement therapy with l-T4 in athyreotic adult patients affected by CH and adult patients with thyroid nodular or cancer diseases treated by total thyroidectomy. DESIGN AND METHODS: A total of 36 adult patients (27 females and nine males) aged 18-29 years were studied; 13 patients (age: 21.5±2.1, group CH) had athyreotic CH treated with l-T4 since the first days of life. The remaining 23 patients (age: 24±2.7, group AH) had hypothyroidism after total thyroidectomy (14 patients previously affected by nodular disease and nine by thyroid carcinoma with clinical and biochemical remission). Patient weight, serum free thyroid hormones, TSH, thyroglobulin (Tg), anti-Tg, and anti-thyroperoxidase antibodies were measured. Required l-T4 dosage was evaluated. At the time of the observations, all patients presented free thyroid hormones within the normal range and TSH between 0.8 and 2 μIU/ml. RESULTS: Patients had undetectable Tg and anti-thyroid antibodies. The daily weight-based dosage of the replacement therapy with l-T4 to reach euthyroidism in patients of group CH was significantly higher than that in those of group AH (2.16±0.36 vs 1.73±0.24 μg/kg, P<0.005). Patients of group CH treated with l-T4 had significantly higher serum TSH levels than patients of group AH (P=0.05) as well as higher FT4 concentrations. CONCLUSIONS: To correct hypothyroidism, patients of group CH required a daily l-T4 dose/kg higher than group AH patients, despite higher levels of TSH. The different requirement of replacement therapy between adult patients with congenital and those with surgical athyroidism could be explained by a lack of thyroid hormones since fetal life in CH, which could determine a different set point of the hypothalamus-pituitary-thyroid axis. SN - 1479-683X UR - https://www.unboundmedicine.com/medline/citation/25305309/The_different_requirement_of_L_T4_therapy_in_congenital_athyreosis_compared_with_adult_acquired_hypothyroidism_suggests_a_persisting_thyroid_hormone_resistance_at_the_hypothalamic_pituitary_level_ L2 - https://eje.bioscientifica.com/doi/10.1530/EJE-14-0621 DB - PRIME DP - Unbound Medicine ER -