ReviewReviews in endocrine & metabolic disorders2022
Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults.
Review in Reviews in endocrine & metabolic disorders, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
29 citing papers in PubMed, 3 syntheses or guidelines pooled it, 47 citations in OpenAlex.
- ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism.European thyroid journal · 2025Guideline
- Pooled it
- Therapeutic efficacy and patient compliance of levothyroxine liquid and softgel formulations taken with meals: a systematic review.Endocrine · 2025Pooled it
- Probiotics and Prebiotics in Subclinical Hypothyroidism of Pregnancy with Small Intestinal Bacterial Overgrowth.Probiotics and antimicrobial proteins · 2024Trial
- Food intolerance/malabsorption in Hashimoto's thyroiditis.Clinics (Sao Paulo, Brazil) · 2026Article
- [Clinical determinants of levothyroxine dosage adjusted for various body weights].Revista medica del Instituto Mexicano del Seguro Social · 2026Article
- Association Between the Levothyroxine Therapy and the Levels of Anti-Thyroid Antibodies in Women with Hypothyroidism Due to Hashimoto's Thyroiditis-Narrative Review.International journal of molecular sciences · 2026Review
- Review
- Betel leaf (paan) chewing: an unusual cause of refractory hypothyroidism in levothyroxine-treated patient.JCEM case reports · 2026Article
- Thyroid Hormone Replacement Dose Is Not Associated with Anti-TPO and Anti-TG Antibody Titers in Hashimoto's Disease.Journal of clinical medicine · 2026Article
- [Evaluation of sodium levothyroxine absorption in real clinical practice using a single-bolus oral test].Problemy endokrinologii · 2026Article
- Physician and hospital determinants of levothyroxine treatment adequacy in low-risk papillary thyroid carcinoma.Frontiers in endocrinology · 2026Article
- Smart thyroid-regulated drug delivery systems: a review of intelligent biosensor-integrated therapeutics for precision thyroxine replacement.Frontiers in endocrinology · 2026Review
- A Clinical Risk Score for Thyroid Hormone Therapy After Partial Thyroidectomy.The Journal of surgical research · 2025Article
- Italian guidelines for the management of adult individuals with primary hypothyroidism outside pregnancy.Journal of endocrinological investigation · 2025Article
- The relationship between levothyroxine dosage and free thyroxine levels in hypothyroid patients: a large retrospective study.European thyroid journal · 2025Article
- The impact of weight loss interventions on thyroid function: a systematic review and meta-analysis.Annals of medicine and surgery (2012) · 2025Review
- Pseudo-Malabsorption in High Dose Levothyroxine-Resistant Hypothyroidism.JCEM case reports · 2025Article
- Levothyroxine dose prediction post-thyroidectomy for differentiated thyroid carcinoma.Frontiers in endocrinology · 2025Article
- Developing a machine learning-based predictive model for levothyroxine dosage estimation in hypothyroid patients: a retrospective study.Frontiers in endocrinology · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 5 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Levothyroxine (LT4) is a safe, effective means of hormone replacement therapy for hypothyroidism. Here, we review the pharmaceutical, pathophysiological and behavioural factors influencing the absorption, distribution, metabolism and excretion of LT4. Any factor that alters the state of the epithelium in the stomach or small intestine will reduce and/or slow absorption of LT4; these include ulcerative colitis, coeliac disease, bariatric surgery, Helicobacter pylori infection, food intolerance, gastritis, mineral supplements, dietary fibre, resins, and various drugs. Once in the circulation, LT4 is almost fully bound to plasma proteins. Although free T4 (FT4) and liothyronine concentrations are extensively buffered, it is possible that drug- or disorder-induced changes in plasma proteins levels can modify free hormone levels. The data on the clinical significance of genetic variants in deiodinase genes are contradictory, and wide-scale genotyping of hypothyroid patients is not currently justified. We developed a decision tree for the physician faced with an abnormally high thyroid-stimulating hormone (TSH) level in a patient reporting adequate compliance with the recommended LT4 dose. The physician should review medications, the medical history and the serum FT4 level and check for acute adrenal insufficiency, heterophilic anti-TSH antibodies, antibodies against gastric and intestinal components (gastric parietal cells, endomysium, and tissue transglutaminase 2), and Helicobacter pylori infection. The next step is an LT4 pharmacodynamic absorption test; poor LT4 absorption should prompt a consultation with a gastroenterologist and (depending on the findings) an increase in the LT4 dose level. An in-depth etiological investigation can reveal visceral disorders and, especially, digestive tract disorders.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.