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Small changes in thyroxine dose do not alter symptoms or well-being in patients with hypothyroidism
The background of the study. Patients with hypothyroidism may continue to have symptoms despite taking thyroxine (T4) in doses that restore their high serum thyrotropin (TSH) concentrations to normal. In this study, patients with hypothyroidism were treated with varying doses of T4 to determine if there were differences in symptoms when the patients’ serum TSH concentration varied within the normal range.
How the study was done. The study subjects were 56 patients with hypothyroidism. All had been treated with at least 100 mg of T4 daily for at least six months, and all had a normal serum TSH concentration at their first visit. The patients received three different doses of T4, each for eight weeks, in random order. These doses were intended to result in serum TSH concentrations of 2.0 to 4.8 mU/L (low dose), 0.3 to 1.9 mU/L (middle dose), and <0.3 mU/L (high dose). At the end of each period, the patients completed questionnaires that assessed general well-being, quality of life, psychological function, hypothyroid symptoms, and cognitive function.
The results of the study. The mean daily T4 doses were 103 µg during the low-dose period, 127 µg during the middle-dose period, and 152 µg during the high-dose period; these doses resulted in mean serum TSH values of 2.8, 1.0, and 0.3 mU/L, respectively. There were no differences in the scores for any of the questionnaires at the end of any of the three treatment periods. At the end of the study, 32 percent preferred the low dose of T4, 26 percent the middle dose, and 20 percent the high dose; 22 percent had no preference.
The conclusions of the study. Among patients with hypothyroidism, treatment with different doses of T4 that result in small changes in serum TSH concentrations within or slightly below the normal range do not result in changes in well-being, quality of life, psychological symptoms, or hypothyroid symptoms.
The original article. Walsh JP, Ward LC, Burke V, Bhagat CI, Shiels L, Henley D, Gillett MJ, Gilbert R, Tanner M, Stuckey BG. Small changes in thyroxine dosage do not produce measurable changes in hypothyroid symptoms, well-being, or quality of life: results of a double-blind, randomized clinical trial. J Clin Endocrinol Metab 2006;91:2624-30.
Next Article: Therapy with thyroxine and triiodothyronine is not more effective than thyroxine alone in patients with hypothyroidism |
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| Thyroid Digest Index | | | November 2006 Thyroid Digest |
