Primary hypothyroidism in the community: Lower daily dosages of levothyroxine replacement therapy for Asian patients

Ngiap Chuan Tan, Rong Quan Chew, Yi Ling Eileen Koh, Reena Chandini Subramanian, Usha Sankari, Meykkumar Meyappan, Li Wei Cho, Ngiap Chuan Tan, Rong Quan Chew, Yi Ling Eileen Koh, Reena Chandini Subramanian, Usha Sankari, Meykkumar Meyappan, Li Wei Cho

Abstract

The goal of treatment in patients with primary hypothyroidism is to attain euthyroidism guided by the stipulated thyroid-stimulating hormone (TSH) levels range so as to minimize any potential long-term adverse effects. However, various factors may result in their Levothyroxine (T4) under and over-replacement.Our study aimed to evaluate the mean daily dose of L-T4 replacement for Asian patients with primary hypothyroidism. The secondary aims were to determine the proportion of those who were either over or under-replaced, and the factors associated with their thyroid function status and replacement adherence.Data collected using questionnaire survey from targeted patients managed in a typical public primary care center in Singapore: socio-demographic characteristics, clinical parameters, laboratory investigations, mean daily L-T4-replacement doses, and replacement regimens. The thyroid status of patients was classified based on thyroid function investigations.Complete data of 229 patients were analyzed. A total of 59.8% of patients had TSH within the normal range, 27.5% and 12.7% were under and over-replaced, respectively. About 60% of Asian patients with primary hypothyroidism achieved normal TSH status requiring average of 1.1 μg of daily L-T4/kgBW (kg body weight). Subjects who were over-replaced had a higher daily L-T4 dose/kgBW when compared to the euthyroid and the under replaced groups. Those with L-T4 over-replacement were largely due to excessive dosage. Patients who were younger, from lower socioeconomic strata, and higher BMI were more likely to be over or under-replaced.Majority of Asian patients with hypothyroidism required replacement of 1.1 μg of daily L-T4/kgBW. Their thyroid status was influenced by demographic and dosing factors.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Percentages were based on 183 cases. A total of 46 cases which did not fall into the above categories were excluded from the bar chart. The following categories were excluded: FT4 > 14.4 pmol/L, TSH > 3.70 mU/L, FT4 > 14.4 pmol/L, TSH from 0.65 to 3.70 mU/L, FT4 

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