Skip to main content
SpringerLink
Log in

Importance of Thyroid Hormone Replacement Therapy in Patients with Medullary Thyroid Cancer

  • Chapter
  • First Online:
Medullary Thyroid Cancer

  • 663 Accesses

Abstract

Levothyroxine (LT4) replacement should be promptly initiated in patients who have undergone thyroidectomy for a diagnosis of medullary thyroid cancer in order to avoid any period of hypothyroidism . LT4 requirement is generally higher than that in patients with autoimmune hypothyroidism and decreases as a patient progresses from childhood to adulthood. The goal of therapy is a normal serum TSH, prevention of any symptoms of hypothyroidism , and ideally patient well-being and satisfaction. Levothyroxine should be administered in a schedule that the patient is able to adhere to, with awareness of medications such as calcium supplements, proton pump inhibitors, and tyrosine kinase inhibitors that may increase a patient’s requirement for LT4. Patient education about lifelong dependence on exogenous LT4 is essential. There are multiple issues with being dependent on LT4 administration that may affect patients across their life span. These include remembering to take LT4 during childhood and adolescence, increased LT4 requirement during pregnancy in young adulthood, and avoidance of iatrogenic thyroid disease in all treated patients, but particularly avoidance of iatrogenic hyperthyroidism in older individuals. Quality of life may not be optimized in all patients taking LT4. Whether this may be addressed by providing a sustained release liothyronine preparation in combination with LT4 remains an area of future research.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid Off J Am Thyroid Assoc. 2014;24(12):1670–751.

    Article  Google Scholar 

  2. Lafranchi S. Hypothyroidism in infants, children, and aldolescents: acquired hypothyroidism (Chap. 54C). In: Braverman LE, Cooper DS, editors. Werner & Ingbar’s the thyroid (10th ed.). Philadelphia, PA: Wolters Kluwer; 2012.

    Google Scholar 

  3. Gregerman RI, Gaffney GW, Shock NW, Crowder SE. Thyroxine turnover in euthyroid man with special reference to changes with age. J Clin Investig. 1962;41:2065–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Haddad HM. Rates of I 131-labeled thyroxine metabolism in euthyroid children. J Clin Investig. 1960;39:1590–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Lafranchi S. Thyroiditis and acquired hypothyroidism. Pediatr Ann. 1992;21(1):29, 32–9.

    Article  Google Scholar 

  6. Vliet GV, Deladoey J. Hypothyroidism in Infants, Children, and Adolescents: Acquired Hypothyroidism in Treatment of Hypothyroidism in Werner & Ingbar’s The Thyroid: A Fundamental and Clinical Text. Lipincott: Tenth Edition edited by Lewis Braverman and David Cooper; 2012.

    Google Scholar 

  7. Lafranchi S. Acquired hypothyroidism in childhood and adolescence. wwwuptodatecom.

    Google Scholar 

  8. Hung W. Thyroid gland. In: Hung W, editor. Clinical pediatric endocrinology. St Loius, MO: Mosby Year Book, Inc; 1992.

    Google Scholar 

  9. Bartalena L, Martino E, Pacchiarotti A, Grasso L, Aghini-Lombardi F, Buratti L, et al. Factors affecting suppression of endogenous thyrotropin secretion by thyroxine treatment: retrospective analysis in athyreotic and goitrous patients. J Clin Endocrinol Metab. 1987;64(4):849–55.

    Article  CAS  PubMed  Google Scholar 

  10. Lodish M, Gkourogianni A, Bornstein E, Sinaii N, Fox E, Chuk M, et al. Patterns of thyroid hormone levels in pediatric medullary thyroid carcinoma patients on vandetanib therapy. Int J Pediatr Endocrinol. 2015;2015(1):3.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Devdhar M, Drooger R, Pehlivanova M, Singh G, Jonklaas J. Levothyroxine replacement doses are affected by gender and weight, but not age. Thyroid Off J Am Thyroid Assoc. 2011;21(8):821–7.

    Article  CAS  Google Scholar 

  12. Jonklaas J. Sex and age differences in levothyroxine dosage requirement. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 2010;16(1):71–9.

    Google Scholar 

  13. Gordon MB, Gordon MS. Variations in adequate levothyroxine replacement therapy in patients with different causes of hypothyroidism. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 1999;5(5):233–8.

    CAS  Google Scholar 

  14. Burmeister LA, Goumaz MO, Mariash CN, Oppenheimer JH. Levothyroxine dose requirements for thyrotropin suppression in the treatment of differentiated thyroid cancer. J Clin Endocrinol Metab. 1992;75(2):344–50.

    CAS  PubMed  Google Scholar 

  15. Sukumar R, Agarwal A, Gupta S, Mishra A, Agarwal G, Verma AK, et al. Prediction of LT4 replacement dose to achieve euthyroidism in subjects undergoing total thyroidectomy for benign thyroid disorders. World J Surg. 2010;34(3):527–31.

    Article  PubMed  Google Scholar 

  16. Olubowale O, Chadwick DR. Optimization of thyroxine replacement therapy after total or near-total thyroidectomy for benign thyroid disease. Br J Surg. 2006;93(1):57–60.

    Article  CAS  PubMed  Google Scholar 

  17. Di Donna V, Santoro MG, de Waure C, Ricciato MP, Paragliola RM, Pontecorvi A, et al. A new strategy to estimate levothyroxine requirement after total thyroidectomy for benign thyroid disease. Thyroid Off J Am Thyroid Assoc. 2014;24(12):1759–64.

    Article  Google Scholar 

  18. Mistry D, Atkin S, Atkinson H, Gunasekaran S, Sylvester D, Rigby AS, et al. Predicting thyroxine requirements following total thyroidectomy. Clin Endocrinol. 2011;74(3):384–7.

    Article  CAS  Google Scholar 

  19. Ojomo KA, Schneider DF, Reiher AE, Lai N, Schaefer S, Chen H, et al. Using body mass index to predict optimal thyroid dosing after thyroidectomy. J Am Coll Surg. 2013;216(3):454–60.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wells SA Jr, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, et al. Revised american thyroid association guidelines for the management of medullary thyroid carcinoma. Thyroid Off J Am Thyroid Assoc. 2015;25(6):567–610.

    Article  Google Scholar 

  21. Baloch Z, Carayon P, Conte-Devolx B, Demers LM, Feldt-Rasmussen U, Henry JF, et al. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid Off J Am Thyroid Assoc. 2003;13(1):3–126.

    Article  Google Scholar 

  22. Surks MI, Boucai L. Age- and race-based serum thyrotropin reference limits. J Clin Endocrinol Metab. 2010;95(2):496–502.

    Article  CAS  PubMed  Google Scholar 

  23. Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002;87(2):489–99.

    Article  CAS  PubMed  Google Scholar 

  24. Boeving A, Paz-Filho G, Radominski RB, Graf H, Amaral de Carvalho G. Low-normal or high-normal thyrotropin target levels during treatment of hypothyroidism: a prospective, comparative study. Thyroid Off J Am Thyroid Assoc. 2011;21(4):355–60.

    Article  CAS  Google Scholar 

  25. Walsh JP, Ward LC, Burke V, Bhagat CI, Shiels L, Henley D, et al. Small changes in thyroxine dosage do not produce measurable changes in hypothyroid symptoms, well-being, or quality of life: results of a double-blind, randomized clinical trial. J Clin Endocrinol Metab. 2006;91(7):2624–30.

    Article  CAS  PubMed  Google Scholar 

  26. Parle JV, Franklyn JA, Cross KW, Jones SR, Sheppard MC. Thyroxine prescription in the community: serum thyroid stimulating hormone level assays as an indicator of undertreatment or overtreatment. Br J General Pract J R Coll Gen Pract. 1993;43(368):107–9.

    CAS  Google Scholar 

  27. Somwaru LL, Arnold AM, Joshi N, Fried LP, Cappola AR. High frequency of and factors associated with thyroid hormone over-replacement and under-replacement in men and women aged 65 and over. J Clin Endocrinol Metab. 2009;94(4):1342–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med. 2000;160(4):526–34.

    Article  CAS  PubMed  Google Scholar 

  29. Klein I, Trzepacz PT, Roberts M, Levey GS. Symptom rating scale for assessing hyperthyroidism. Arch Intern Med. 1988;148(2):387–90.

    Article  CAS  PubMed  Google Scholar 

  30. Cooper DS, Biondi B. Subclinical thyroid disease. Lancet. 2012;379(9821):1142–54.

    Article  PubMed  Google Scholar 

  31. Popoveniuc G, Chandra T, Sud A, Sharma M, Blackman MR, Burman KD, et al. A diagnostic scoring system for myxedema coma. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 2014;20(8):808–17.

    Google Scholar 

  32. Bach-Huynh TG, Nayak B, Loh J, Soldin S, Jonklaas J. Timing of levothyroxine administration affects serum thyrotropin concentration. J Clin Endocrinol Metab. 2009;94(10):3905–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Bolk N, Visser TJ, Nijman J, Jongste IJ, Tijssen JG, Berghout A. Effects of evening vs morning levothyroxine intake: a randomized double-blind crossover trial. Arch Intern Med. 2010;170(22):1996–2003.

    Article  CAS  PubMed  Google Scholar 

  34. Conrad SC, Chiu H, Silverman BL. Soy formula complicates management of congenital hypothyroidism. Arch Dis Child. 2004;89(1):37–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Jabbar MA, Larrea J, Shaw RA. Abnormal thyroid function tests in infants with congenital hypothyroidism: the influence of soy-based formula. J Am Coll Nutr. 1997;16(3):280–2.

    Article  CAS  PubMed  Google Scholar 

  36. Ritter K, Elfenbein D, Schneider DF, Chen H, Sippel RS. Hypoparathyroidism after total thyroidectomy: incidence and resolution. J Surg Res. 2015;197(2):348–53.

    Article  CAS  PubMed  Google Scholar 

  37. Toniato A, Boschin IM, Piotto A, Pelizzo MR, Guolo A, Foletto M, et al. Complications in thyroid surgery for carcinoma: one institution’s surgical experience. World J Surg. 2008;32(4):572–5.

    Article  PubMed  Google Scholar 

  38. Scholz S, Smith JR, Chaignaud B, Shamberger RC, Huang SA. Thyroid surgery at Children’s Hospital Boston: a 35-year single-institution experience. J Pediatr Surg. 2011;46(3):437–42.

    Article  PubMed  Google Scholar 

  39. Rafferty MA, Goldstein DP, Rotstein L, Asa SL, Panzarella T, Gullane P, et al. Completion thyroidectomy versus total thyroidectomy: is there a difference in complication rates? An analysis of 350 patients. J Am Coll Surg. 2007;205(4):602–7.

    Article  PubMed  Google Scholar 

  40. Serpell JW, Phan D. Safety of total thyroidectomy. ANZ J Surg. 2007;77(1–2):15–9.

    Article  PubMed  Google Scholar 

  41. Noureldine SI, Genther DJ, Lopez M, Agrawal N, Tufano RP. Early predictors of hypocalcemia after total thyroidectomy: an analysis of 304 patients using a short-stay monitoring protocol. JAMA Otolaryngol Head Neck Surg. 2014;140(11):1006–13.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Burge MR, Zeise TM, Johnsen MW, Conway MJ, Qualls CR. Risks of complication following thyroidectomy. J Gen Intern Med. 1998;13(1):24–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Puzziello A, Rosato L, Innaro N, Orlando G, Avenia N, Perigli G, et al. Hypocalcemia following thyroid surgery: incidence and risk factors. A longitudinal multicenter study comprising 2,631 patients. Endocrine. 2014;47(2):537–42.

    Article  CAS  PubMed  Google Scholar 

  44. Sosa JA, Tuggle CT, Wang TS, Thomas DC, Boudourakis L, Rivkees S, et al. Clinical and economic outcomes of thyroid and parathyroid surgery in children. J Clin Endocrinol Metab. 2008;93(8):3058–65.

    Article  CAS  PubMed  Google Scholar 

  45. Singh N, Singh PN, Hershman JM. Effect of calcium carbonate on the absorption of levothyroxine. JAMA. 2000;283(21):2822–5.

    Article  CAS  PubMed  Google Scholar 

  46. Singh N, Weisler SL, Hershman JM. The acute effect of calcium carbonate on the intestinal absorption of levothyroxine. Thyroid Off J Am Thyroid Assoc. 2001;11(10):967–71.

    Article  CAS  Google Scholar 

  47. Zamfirescu I, Carlson HE. Absorption of levothyroxine when coadministered with various calcium formulations. Thyroid Off J Am Thyroid Assoc. 2011;21(5):483–6.

    Article  CAS  Google Scholar 

  48. Sachmechi I, Reich DM, Aninyei M, Wibowo F, Gupta G, Kim PJ. Effect of proton pump inhibitors on serum thyroid-stimulating hormone level in euthyroid patients treated with levothyroxine for hypothyroidism. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 2007;13(4):345–9.

    Google Scholar 

  49. Ebert EC. The parathyroids and the gut. J Clin Gastroenterol. 2010;44(7):479–82.

    PubMed  Google Scholar 

  50. Abboud B, Daher R, Boujaoude J. Digestive manifestations of parathyroid disorders. World J Gastroenterol (WJG). 2011;17(36):4063–6.

    Article  Google Scholar 

  51. Cohen MS, Phay JE, Albinson C, DeBenedetti MK, Skinner MA, Lairmore TC, et al. Gastrointestinal manifestations of multiple endocrine neoplasia type 2. Ann Surg. 2002;235(5):648–54 (discussion 54–5).

    Article  PubMed  PubMed Central  Google Scholar 

  52. Demos TC, Blonder J, Schey WL, Braithwaite SS, Goldstein PL. Multiple endocrine neoplasia (MEN) syndrome type IIB: gastrointestinal manifestations. AJR Am J Roentgenol. 1983;140(1):73–8.

    Article  CAS  PubMed  Google Scholar 

  53. Vita R, Saraceno G, Trimarchi F, Benvenga S. Switching levothyroxine from the tablet to the oral solution formulation corrects the impaired absorption of levothyroxine induced by proton-pump inhibitors. J Clin Endocrinol Metab. 2014;99(12):4481–6.

    Article  CAS  PubMed  Google Scholar 

  54. Vita R, Fallahi P, Antonelli A, Benvenga S. The administration of L-thyroxine as soft gel capsule or liquid solution. Expert Opin Drug Deliv. 2014;11(7):1103–11.

    Article  CAS  PubMed  Google Scholar 

  55. Wells SA Jr, Robinson BG, Gagel RF, Dralle H, Fagin JA, Santoro M, et al. Vandetanib in patients with locally advanced or metastatic medullary thyroid cancer: a randomized, double-blind phase III trial. J Clin Oncol Off J Am Soc Clin Oncol. 2012;30(2):134–41.

    Article  CAS  Google Scholar 

  56. Brassard M, Neraud B, Trabado S, Salenave S, Brailly-Tabard S, Borget I, et al. Endocrine effects of the tyrosine kinase inhibitor vandetanib in patients treated for thyroid cancer. J Clin Endocrinol Metab. 2011;96(9):2741–9.

    Article  CAS  PubMed  Google Scholar 

  57. Schlumberger MJ, Elisei R, Bastholt L, Wirth LJ, Martins RG, Locati LD, et al. Phase II study of safety and efficacy of motesanib in patients with progressive or symptomatic, advanced or metastatic medullary thyroid cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2009;27(23):3794–801.

    Article  CAS  Google Scholar 

  58. Abdulrahman RM, Verloop H, Hoftijzer H, Verburg E, Hovens GC, Corssmit EP, et al. Sorafenib-induced hypothyroidism is associated with increased type 3 deiodination. J Clin Endocrinol Metab. 2010;95(8):3758–62.

    Article  CAS  PubMed  Google Scholar 

  59. Kemper AR, Ouyang L, Grosse SD. Discontinuation of thyroid hormone treatment among children in the United States with congenital hypothyroidism: findings from health insurance claims data. BMC Pediatr. 2010;10:9.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Morris LF, Waguespack SG, Warneke CL, Ryu H, Ying AK, Anderson BJ, et al. Long-term follow-up data may help manage patient and parent expectations for pediatric patients undergoing thyroidectomy. Surgery. 2012;152(6):1165–71.

    Article  PubMed  Google Scholar 

  61. Francis G, Waguespack SG, Bauer AJ, Angelos P, Benvenga S, Cerutti J, et al. Management guidelines for children with thyroid nodules and differentiated thyroid cancer The American Thyroid Association guidelines task force on pediatric thyroid cancer. Thyroid Off J Am Thyroid Assoc. 2015.

    Google Scholar 

  62. Pinto BM, Floyd A. Theories underlying health promotion interventions among cancer survivors. Semin Oncol Nurs. 2008;24(3):153–63.

    Article  PubMed  Google Scholar 

  63. Martins RK, McNeil DW. Review of motivational interviewing in promoting health behaviors. Clin Psychol Rev. 2009;29(4):283–93.

    Article  PubMed  Google Scholar 

  64. Lomenick JP, Wang L, Ampah SB, Saville BR, Greenwald FI. Generic levothyroxine compared with synthroid in young children with congenital hypothyroidism. J Clin Endocrinol Metab. 2013;98(2):653–8.

    Article  CAS  PubMed  Google Scholar 

  65. Carswell JM, Gordon JH, Popovsky E, Hale A, Brown RS. Generic and brand-name L-thyroxine are not bioequivalent for children with severe congenital hypothyroidism. J Clin Endocrinol Metab. 2013;98(2):610–7.

    Article  CAS  PubMed  Google Scholar 

  66. Ramsey S, Blough D, Kirchhoff A, Kreizenbeck K, Fedorenko C, Snell K, et al. Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff. 2013;32(6):1143–52.

    Article  Google Scholar 

  67. Carhill AA, Cabanillas ME, Jimenez C, Waguespack SG, Habra MA, Hu M, et al. The noninvestigational use of tyrosine kinase inhibitors in thyroid cancer: establishing a standard for patient safety and monitoring. J Clin Endocrinol Metab. 2013;98(1):31–42.

    Article  CAS  PubMed  Google Scholar 

  68. Fluchel MN, Kirchhoff AC, Bodson J, Sweeney C, Edwards SL, Ding Q, et al. Geography and the burden of care in pediatric cancers. Pediatr Blood Cancer. 2014;61(11):1918–24.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Guy GP Jr, Ekwueme DU, Yabroff KR, Dowling EC, Li C, Rodriguez JL, et al. Economic burden of cancer survivorship among adults in the United States. J Clin Oncol Off J Am Soc Clin Oncol. 2013;31(30):3749–57.

    Article  Google Scholar 

  70. Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid Off J Am Thyroid Assoc. 2011;21(10):1081–125.

    Article  Google Scholar 

  71. Loh JA, Wartofsky L, Jonklaas J, Burman KD. The magnitude of increased levothyroxine requirements in hypothyroid pregnant women depends upon the etiology of the hypothyroidism. Thyroid Off J Am Thyroid Assoc. 2009;19(3):269–75.

    Article  CAS  Google Scholar 

  72. Sawin CT, Geller A, Wolf PA, Belanger AJ, Baker E, Bacharach P, et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med. 1994;331(19):1249–52.

    Article  CAS  PubMed  Google Scholar 

  73. Surks MI, Hollowell JG. Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population: implications for the prevalence of subclinical hypothyroidism. J Clin Endocrinol Metab. 2007;92(12):4575–82.

    Article  CAS  PubMed  Google Scholar 

  74. Boucai L, Hollowell JG, Surks MI. An approach for development of age-, gender-, and ethnicity-specific thyrotropin reference limits. Thyroid Off J Am Thyroid Assoc. 2011;21(1):5–11.

    Article  Google Scholar 

  75. Leboeuf R, Perron P, Carpentier AC, Verreault J, Langlois MF. L-T3 preparation for whole-body scintigraphy: a randomized-controlled trial. Clin Endocrinol. 2007;67(6):839–44.

    Article  CAS  Google Scholar 

  76. Saravanan P, Chau WF, Roberts N, Vedhara K, Greenwood R, Dayan CM. Psychological well-being in patients on ‘adequate’ doses of l-thyroxine: results of a large, controlled community-based questionnaire study. Clin Endocrinol. 2002;57(5):577–85.

    Article  CAS  Google Scholar 

  77. Wekking EM, Appelhof BC, Fliers E, Schene AH, Huyser J, Tijssen JG, et al. Cognitive functioning and well-being in euthyroid patients on thyroxine replacement therapy for primary hypothyroidism. Eur J Endocrinol/Eur Fed Endocr Soc. 2005;153(6):747–53.

    Article  CAS  Google Scholar 

  78. Jonklaas J, Davidson B, Bhagat S, Soldin SJ. Triiodothyronine levels in athyreotic individuals during levothyroxine therapy. JAMA. 2008;299(7):769–77.

    Article  CAS  PubMed  Google Scholar 

  79. Fish LH, Schwartz HL, Cavanaugh J, Steffes MW, Bantle JP, Oppenheimer JH. Replacement dose, metabolism, and bioavailability of levothyroxine in the treatment of hypothyroidism. Role of triiodothyronine in pituitary feedback in humans. N Engl J Med. 1987;316(13):764–70.

    Article  CAS  PubMed  Google Scholar 

  80. Gullo D, Latina A, Frasca F, Le Moli R, Pellegriti G, Vigneri R. Levothyroxine monotherapy cannot guarantee euthyroidism in all athyreotic patients. PLoS ONE. 2011;6(8):e22552.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  81. Ito M, Miyauchi A, Morita S, Kudo T, Nishihara E, Kihara M, et al. TSH-suppressive doses of levothyroxine are required to achieve preoperative native serum triiodothyronine levels in patients who have undergone total thyroidectomy. Eur J Endocrinol/Eur Fed Endocr Soc. 2012;167(3):373–8.

    Article  CAS  Google Scholar 

  82. Pilo A, Iervasi G, Vitek F, Ferdeghini M, Cazzuola F, Bianchi R. Thyroidal and peripheral production of 3,5,3′-triiodothyronine in humans by multicompartmental analysis. Am J Physiol. 1990;258(4 Pt 1):E715–26.

    CAS  PubMed  Google Scholar 

  83. Escobar-Morreale HF, Obregon MJ, Escobar del Rey F, Morreale de Escobar G. Replacement therapy for hypothyroidism with thyroxine alone does not ensure euthyroidism in all tissues, as studied in thyroidectomized rats. J Clin Investig. 1995;96(6):2828–38.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  84. Escobar-Morreale HF, del Rey FE, Obregon MJ, de Escobar GM. Only the combined treatment with thyroxine and triiodothyronine ensures euthyroidism in all tissues of the thyroidectomized rat. Endocrinology. 1996;137(6):2490–502.

    CAS  PubMed  Google Scholar 

  85. Werneck de Castro JP, Fonseca TL, Ueta CB, McAninch EA, Abdalla S, Wittmann G, et al. Differences in hypothalamic type 2 deiodinase ubiquitination explain localized sensitivity to thyroxine. J Clin Investig. 2015;125(2):769–81.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Ma C, Xie J, Huang X, Wang G, Wang Y, Wang X, et al. Thyroxine alone or thyroxine plus triiodothyronine replacement therapy for hypothyroidism. Nucl Med Commun. 2009;30(8):586–93.

    Article  CAS  PubMed  Google Scholar 

  87. Joffe RT, Brimacombe M, Levitt AJ, Stagnaro-Green A. Treatment of clinical hypothyroidism with thyroxine and triiodothyronine: a literature review and metaanalysis. Psychosomatics. 2007;48(5):379–84.

    Article  CAS  PubMed  Google Scholar 

  88. Grozinsky-Glasberg S, Fraser A, Nahshoni E, Weizman A, Leibovici L. Thyroxine-triiodothyronine combination therapy versus thyroxine monotherapy for clinical hypothyroidism: meta-analysis of randomized controlled trials. J Clin Endocrinol Metab. 2006;91(7):2592–9.

    Article  CAS  PubMed  Google Scholar 

  89. Saravanan P, Simmons DJ, Greenwood R, Peters TJ, Dayan CM. Partial substitution of thyroxine (T4) with tri-iodothyronine in patients on T4 replacement therapy: results of a large community-based randomized controlled trial. J Clin Endocrinol Metab. 2005;90(2):805–12.

    Article  CAS  PubMed  Google Scholar 

  90. Panicker V, Saravanan P, Vaidya B, Evans J, Hattersley AT, Frayling TM, et al. Common variation in the DIO2 gene predicts baseline psychological well-being and response to combination thyroxine plus triiodothyronine therapy in hypothyroid patients. J Clin Endocrinol Metab. 2009;94(5):1623–9.

    Article  CAS  PubMed  Google Scholar 

  91. de Jong FJ, Peeters RP, den Heijer T, van der Deure WM, Hofman A, Uitterlinden AG, et al. The association of polymorphisms in the type 1 and 2 deiodinase genes with circulating thyroid hormone parameters and atrophy of the medial temporal lobe. J Clin Endocrinol Metab. 2007;92(2):636–40.

    Article  PubMed  Google Scholar 

  92. Hoang TD, Olsen CH, Mai VQ, Clyde PW, Shakir MK. Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study. J Clin Endocrinol Metab. 2013;98(5):1982–90.

    Article  CAS  PubMed  Google Scholar 

  93. Celi FS, Zemskova M, Linderman JD, Smith S, Drinkard B, Sachdev V, et al. Metabolic effects of liothyronine therapy in hypothyroidism: a randomized, double-blind, crossover trial of liothyronine versus levothyroxine. J Clin Endocrinol Metab. 2011;96(11):3466–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Endocrinology, Georgetown University, Suite 230, Bldg. D, 4000 Reservoir Road, NW, Washington, DC, 20007, USA

    Jacqueline Jonklaas

Authors
  1. Jacqueline Jonklaas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jacqueline Jonklaas .

Editor information

Editors and Affiliations

  1. Associate Professor of Surgery; Chief, Section of Endocrine Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    Tracy S. Wang

  2. Donald C. Ausman Family Foundation Professor in Surgery and Chair, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    Douglas B. Evans

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Jonklaas, J. (2016). Importance of Thyroid Hormone Replacement Therapy in Patients with Medullary Thyroid Cancer. In: Wang, T., Evans, D. (eds) Medullary Thyroid Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-39412-1_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-39412-1_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-39410-7

  • Online ISBN: 978-3-319-39412-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation