Skip to main content

Advertisement

SpringerLink
Log in

Evaluation of adequacy of levo-thyroxine dosage in patients with differentiated thyroid carcinoma: correlation between morning and afternoon TSH determination

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to judge the reliability of evaluating thyroid-stimulating hormone (TSH) and free thyroxine (f-T4) in the morning and afternoon in differentiated thyroid carcinoma (DTC) patients.

Methods

We evaluated 153 DTC patients, aged 61 ± 13 years, in active follow-up in our center after primary treatments and under stabilized levo-thyroxine (L-T4) posology. In each patient, morning and afternoon examinations were performed 1-3 months apart. Blood samples were collected at 08:00–09:00 h and 15:00–16:00 h. TSH and f-T4 were evaluated in both samples. Thyroglobulin (Tg), Tg-antibodies and neck ultrasonography were also evaluated.

Results

According to clinical and laboratory examinations, 92% of patients were disease-free, 6% had biochemical disease, and 2% structural disease. L-T4 dosages (1.64 ± 0.38 µg/kg b.w.) proved the same on both occasions, despite slight changes in body weight or L-T4 posology in 15% of patients. Free-T4 values were significantly higher in the afternoon (21.5 ± 0.3 pmol/L) than in the morning (18.8 ± 0.4 pmol/L; P < 0.0001), whereas TSH values were statistically unchanged (morning 0.85 ± 0.25 mIU/L; afternoon 0.72 ± 0.20 mIU/L). There was a significant correlation (P < 0.0001) between the two TSH determinations in the same patients.

Conclusions

In DTC patients, follow-up examination consists of clinical and laboratory evaluations. The majority of patients have good disease control. Our study suggests that the adequacy of L-T4 therapy can be monitored equally well either in the morning or in the afternoon. Afternoon examinations can alleviate crowding in hospital ambulatories in the morning.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Schmidbauer B, Menhart K, Hellwig D, Grosse J (2017) Differentiated thyroid cancer-treatment: state of the art. Int J Mol Sci. https://doi.org/10.3390/ijms18061292

    Article  PubMed  PubMed Central  Google Scholar 

  2. Virili C, Trimboli P, Romanelli F, Centanni M (2016) Liquid and softgel levothyroxine use in clinical practise: state of the art. Endocrine 54:3–14

    Article  CAS  Google Scholar 

  3. Benvenga SL, Bartolone L, Squadrito S, Lo Giudice F, Trimarchi F (1995) Delayed intestinal absorption of levothyroxine. Thyroid 5:249–253

    Article  CAS  Google Scholar 

  4. Cappelli C, Pirola I, Daffini L, Formenti A, Iacobello C, Cristiano A, Gandossi E, Agabiti Rosei E, Castellano M (2016) A double-blind placebo-controlled trial of liquid thyroxine ingested at breakfast: results of the TICO study. Thyroid 26:197–202

    Article  CAS  Google Scholar 

  5. Fallahi P, Ferrari SM, Ruffilli I, Ragusa F, Biricotti M, Materazzi G, Miccoli P, Antonelli A (2017) Advancements in the treatment of hypothyroidism with L-T4 liquid formulation or soft gel capsule: an update. Expert Opin Drug Deliv 14:647–655

    Article  CAS  Google Scholar 

  6. Giusti M, Mortara L, Machello N, Monti E, Pera G, Marenzana M (2015) Utility of a liquid formulation of levo-thyroxine in differentiated thyroid cancer patients. Drug Res (Stuttg) 65:332–336

    CAS  Google Scholar 

  7. Cappelli C, Pirola I, Gandossi E, Casella C, Lombardi D, Agosti B, Marini F, Delbarba A, Castellano M (2017) TSH variability of patients affected by differentiated thyroid cancer treated with levothyroxine liquid solution or tablet form. Int J Endocrinol. https://doi.org/10.1155/2017/7053959

    Article  PubMed  PubMed Central  Google Scholar 

  8. McGriff NJ, Csako G, Gourgiotis L, Lori CG, Pucino F, Sarlis NJ (2002) Effects of thyroid hormone suppression therapy on adverse clinical outcomes in thyroid cancer. Ann Med 34:554–564

    Article  CAS  Google Scholar 

  9. Parker WA, Edafe O, Balasubramanian SP (2017) Long-term treatment-related morbidity in differentiated thyroid cancer: a systematic review of the literature. Pragmat Obs Res 16:57–67

    Article  Google Scholar 

  10. Abonowara A, Quraishi A, Sapp JL, Alqambar MH, Saric A, O’Connell CM, Rajaraman MM, Hart RD, Imran SA (2012) Prevalence of atrial fibrillation in patients taking TSH suppression therapy for management of thyroid cancer. Clin Invest Med 35(3):E152–E156

    Article  Google Scholar 

  11. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L (2016) 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26:1–133

    Article  Google Scholar 

  12. Ahn HS, Kim HJ, Welch HJ (2014) Korea’s thyroid-cancer “epidemic”—screening and over diagnosis. N Engl J Med 371:1765–1767

    Article  Google Scholar 

  13. La Vecchia C, Negri E (2017) Thyroid cancer: the thyroid cancer epidemic—overdiagnosis or a real increase? Nat Rev Endocrinol 13:318–319

    Article  Google Scholar 

  14. Lim H, Devesa SS, Sosa JA, Check D, Kitahara CM (2017) Trends in thyroid cancer incidence and mortality in the United States, 1974–2013. JAMA 317:1338–1348

    Article  Google Scholar 

  15. Tuttle RM, Haugen B, Perrier ND (2017) Updated American Joint Committee on Cancer/Tumor-Node-Metastasis Staging System for differentiated and anaplastic thyroid cancer (eighth edition): what changed and why? Thyroid 27:751–756

    Article  Google Scholar 

  16. Sánchez-Carbayo M, Mauri M, Alfayate R, Miralles C, Soria F (1999) Analytical and clinical evaluation of TSH and thyroid hormones by electrochemiluminescent immunoassays. Clin Biochem 32:395–403

    Article  Google Scholar 

  17. Biondi B, Wartofsky L (2014) Treatment with thyroid hormone. Endocr Rev 35:433–512

    Article  CAS  Google Scholar 

  18. Bolton S (2005) Bioequivalence studies for levothyroxine. AAPS J 7:E47–E53

    Article  CAS  Google Scholar 

  19. IMS Institute for Healthcare Informatics (2012) The use of medicines in the United States: review of 2011. IMS Health website. http://www.imshealth.com/ims/Global/Content/Insights/IMS%20Institute%20for%20Healthcare%20Informatics/IHII_Medicines

  20. Cellini M, Santaguida MG, Virili C, Capriello S, Brusca N, Gargano L, Centanni M (2017) Hashimoto’s thyroiditis and autoimmune gastritis. Front Endocrinol 26(8):92

    Article  Google Scholar 

  21. Mirjanic-Azaric B, Stojakovic-Jelisavac T, Vukovic B, Stojanovic D, Vujnic M, Uletilovic S (2015) The impact of time of sample collection on measurement of thyroid stimulating hormone values in the serum. Clin Biochem 48:1347–1349

    Article  CAS  Google Scholar 

  22. Spencer CA, Lum SM, Wiber JF, Kaptein EM, Nicoloff JT (1983) Dynamics of serum thyrotropin and thyroid hormone changes in fasting. J Clin Endocrinol Metab 56:883–888

    Article  CAS  Google Scholar 

  23. Persani L, Terzolo M, Asteria C, Orlandi F, Angeli A, Beck-Peccoz P (1995) Circadian variations of thyrotropin bioactivity in normal subjects and patients with primary hypothyroidism. J Clin Endocrinol Metab 80:2722–2728

    CAS  PubMed  Google Scholar 

  24. Minuto F, Bagnasco M, Giusti M, Grimaldi G, Biassoni P, Ferrini O, Giordano G (1981) Twenty-four profile of integrated TSH concentration in puberty. J Endocriol Invest 4:7–10

    Article  CAS  Google Scholar 

  25. Rose SR, Nisula BC (1989) Circadian variation of thyrotropin in childhood. J Clin Endocrinol Metab 68:1086–1190

    Article  CAS  Google Scholar 

  26. Sviridonova MA, Fadeyev VV, Sych YP, Melnichenko GA (2013) Clinical significance of TSH circadian variability in patients with hypothyroidism. Endocr Res 38:24–31

    Article  CAS  Google Scholar 

  27. Bolk N, Visser TJ, Kalsbeek A, van Domburg RT, Berghout A (2007) Effects of evening vs morning thyroxine ingestion on serum thyroid hormone profiles in hypothyroid patients. Clin Endocrinol (Oxf) 66:43–48

    CAS  Google Scholar 

  28. Bartalena L, Martino E, Falcone M, Buratti L, Grasso L, Mammoli C, Pacchiarotti A, Aghini-Lombardi F, Balzano S, Pinchera A (1987) Evaluation of the nocturnal serum thyrotropin (TSH) surge, as assessed by TSH ultrasensitive assay, in patients receiving long term L-thyroxine suppression therapy and in patients with various thyroid disorders. J Clin Endocrinol Metab 65:1265–1271

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Endocrine Unit, Policlinico San Martino, Viale Benedetto XV, 6, 16100, Genoa, Italy

    L. Conte, E. Monti, S. Gay, A. Adorno, M. Mittica & M. Giusti

  2. Laboratory Medicine Unit, Policlinico San Martino, Genoa, Italy

    P. Marroni & M. Mussap

Authors
  1. L. Conte
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Monti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Gay
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Marroni
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Adorno
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Mittica
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Mussap
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M. Giusti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. Conte.

Ethics declarations

Conflict of interest

No potential conflicts of interest relevant to this article are reported.

Ethical standards

The investigation was conducted according to the principles expressed in the Declaration of Helsinki.

Informed consent

Informed consent to the use of clinical data and information was obtained.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Conte, L., Monti, E., Gay, S. et al. Evaluation of adequacy of levo-thyroxine dosage in patients with differentiated thyroid carcinoma: correlation between morning and afternoon TSH determination. J Endocrinol Invest 41, 1193–1197 (2018). https://doi.org/10.1007/s40618-018-0852-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40618-018-0852-x

Keywords

Search

Navigation