TSH Variability of Patients Affected by Differentiated Thyroid Cancer Treated with Levothyroxine Liquid Solution or Tablet Form

Carlo Cappelli; Ilenia Pirola; Elena Gandossi; Claudio Casella; Davide Lombardi; Barbara Agosti; Fiorella Marini; Andrea Delbarba; Maurizio Castellano

doi:10.1155/2017/7053959

TSH Variability of Patients Affected by Differentiated Thyroid Cancer Treated with Levothyroxine Liquid Solution or Tablet Form

Int J Endocrinol. 2017:2017:7053959. doi: 10.1155/2017/7053959. Epub 2017 May 9.

Authors

Carlo Cappelli¹, Ilenia Pirola¹, Elena Gandossi¹, Claudio Casella², Davide Lombardi³, Barbara Agosti¹, Fiorella Marini¹, Andrea Delbarba¹, Maurizio Castellano¹

Affiliations

¹ Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, Clinica Medica, 2nd Medicina, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy.
² Department of Molecular and Translational Medicine, 3rd Division of General Surgery, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy.
³ Department of Otorhinolaryngology, Spedali Civili di Brescia, 25123 Brescia, Italy.

Abstract

Background: Recent guidelines from the American Thyroid Association (ATA) indicate that, in many patients affected by differentiated thyroid cancer (DTC), the serum TSH should be maintained between 0.1 and 0.5 mU/L. The purpose of this study was to evaluate the TSH variability of patients affected by DTC treated with liquid L-T4 formulation or in tablet form.

Patients and methods: Patients were eligible if (a) they were submitted to a total thyroidectomy and ¹³¹I remnant ablation for DTC in our institution and (b) they were classified low-risk patients according to ATA guidelines 2009. Patients were randomized (1 : 1) to receive treatment of hypothyroidism with liquid L-T4 or tablet form. The first check-up evaluation was made from 8 to 12 months after ¹³¹I remnant ablation. TSH values were established again after further 12 months.

Results: A significant increase in TSH values (median) was observed in patients taking tablets [TSH (min-max): 0.28 (0.1-0.45) versus 0.34 (0.01-0.78) mIU/L, p = 0.041] as compared to those taking liquid formulation [TSH (min-max): 0.28 (0.1-0.47) versus 0.30 (0.1-0.55) mIU/L, p = 0.345].

Conclusions: The use of L-T4 liquid formulation, as compared to that of tablets, resulted in a significantly higher number of DTC patients maintaining TSH values in range for the ATA risk score, reducing TSH variability over the time.