MINI REVIEW article
Front. Endocrinol.
Sec. Thyroid Endocrinology
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1582734
This article is part of the Research TopicLevothyroxine Therapy in Patients with Hypothyroidism: Volume IIView all 13 articles
Levothyroxine Therapy in Thyroidectomized Patients: Ongoing Challenges and Controversies
Provisionally accepted
- 1University of Pisa, Pisa, Italy
- 2Hashemite University, Zarqa, Zarqa, Jordan
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This mini-review provides an update on the challenges and controversies surrounding levothyroxine therapy in thyroidectomized patients, following an extensive review on dosing strategies and available formulations. Despite efforts to establish an ideal dosage adjustment method, achieving optimal thyroid hormone replacement remains complex due to interindividual variations in the hypothalamic-pituitary-thyroid axis and the pharmacokinetic and pharmacodynamic limitations of exogenous levothyroxine.Additionally, this review highlights the importance of evaluating the risk-benefit ratio of levothyroxine therapy, particularly in the setting of TSH suppression, focusing on its effects on quality of life, bone metabolism, and cardiac rhythm. Levothyroxine-induced subclinical hyperthyroidism may contribute to an increased risk of atrial fibrillation and alterations in bone mineral density, with implications that remain a subject of debate. Given the incomplete replication of endogenous thyroid hormone action by levothyroxine monotherapy, a tailored therapeutic approach is crucial. Despite ongoing research, the optimal management of thyroidectomized patients continues to be an open issue.
Keywords: levothyroxine therapy, Thyroidectomy, dose adjustement, personalized therapy, Heart risk, Bone risk, quality of life, Liquid levothyroxine
Received: 24 Feb 2025; Accepted: 08 May 2025.
Copyright: © 2025 Rossi, Paternoster, Cammarata, Bakkar and Miccoli. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Leonardo Rossi, University of Pisa, Pisa, Italy
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