Int J Thyroidol.  2019 May;12(1):28-34. 10.11106/ijt.2019.12.1.28.

Comparison of Thyroid Hormones in Euthyroid Athyreotic Patients Treated with Levothyroxine and Euthyroid Healthy Subjects

• Jeon MJ
• Lee SH
• Lee JJ
• Han MK
• Kim HK
• Kim WG
• Kim TY
• Kim WB
• Shong YK
• Ryu JS

• KMID: 2449063
• DOI: http://doi.org/10.11106/ijt.2019.12.1.28

Abstract

BACKGROUND AND OBJECTIVES
Levothyroxine (L-T4) monotherapy to normalize TSH level might be not sufficient to restore serum free triiodothyronine (fT3) levels in hypothyroid patients. This study aimed to compare the thyroid hormone levels in euthyroid L-T4 treated athyreotic patients and euthyroid healthy control subjects.
MATERIALS AND METHODS
We included 69 euthyroid L-T4 treated athyreotic female patients after total thyroidectomy and radioactive iodine ablation therapy and 90 euthyroid healthy female. Serum fT3 and free thyroxine (fT4) levels were simultaneously measured using two different assay kits (A and B).
RESULTS
The serum fT4 level was higher in the athyreotic patients (kit A: p<0.001, kit B: p=0.046), and the serum fT3 level was higher in control subjects (kit A: p=0.047, kit B: p=0.102). In the control group, the serum fT3 level was stable and not correlated with the TSH level (kit A: tau=−0.10, p=0.18, kit B: tau=−0.06, p=0.40). However, in the patient group, the serum fT3 level was negatively correlated with the TSH level (kit A: tau=−0.22, p=0.012, kit B: tau=−0.31, p<0.001). All thyroid hormone parameters measured by kit A showed higher area under the curve values than those measured by kit B for distinguishing the patients from the control subjects.
CONCLUSION
The serum fT3 levels in L-T4 treated athyreotic euthyroid patients were significantly lower than and varied from those of euthyroid healthy control subjects. Thus, L-T4 monotherapy might not be appropriate for some athyreotic patients to maintain optimal T3 levels.

Keyword

Thyroid hormones; Triiodothyronine; Thyroxine; Thyroidectomy

MeSH Terms

Female
Healthy Volunteers*
Humans
Iodine
Thyroid Gland*
Thyroid Hormones*
Thyroidectomy
Thyroxine*
Triiodothyronine
Iodine
Thyroid Hormones
Thyroxine
Triiodothyronine

Figure

• 

  Fig. 1 Relationship between TSH and free T3, free T4, free T3/free T4 ratio according to the assay kits. (A) free T4, (B) free T3 and (C) free T3/free T4 ratio. a means the Kit A and b means the Kit B. Y-axis shows the thyroid hormone values and X-axis shows the log-transformed TSH values. Non-linear relationship curves were shown as dotted lines. Grey dots and grey dotted lines represent values of patients. Black dots and black dotted lines represent values of controls.

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