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August 8/22, 2005

Levothyroxine Therapy for Hypothyroidism: Should We Abandon Conservative Dosage Titration?

Arch Intern Med. 2005;165(15):1683-1684. doi:10.1001/archinte.165.15.1683

Roos et al1 compared the clinical responses in 25 patients with hypothyroidism treated with gradually incremental doses of levothyroxine, starting with 25 μg/d, with those in 25 matched patients treated from the outset with an approximate full-replacement dosage of 1.6 μg/kg per day. With no adverse sequelae in the latter group, they concluded that a full starting dose is safe, more convenient, and more cost-effective. Roos et al summarized that the rationale for the traditional practice of slowly starting levothyroxine replacement is based on the potential risks that are said to occur with higher doses, such as coronary ischemia, arrhythmia, or myocardial infarction. They refer to this traditional approach as being based on “dogma,” the basis for which having never been studied prospectively. I have several concerns about their study’s conclusions and recommendations.

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