• J. Am. Coll. Surg. · Jan 2016

    Clinical Trial

    Prospective Intervention of a Novel Levothyroxine Dosing Protocol Based on Body Mass Index after Thyroidectomy.

    • Dawn M Elfenbein, Sarah Schaefer, Cynthia Shumway, Herbert Chen, Rebecca S Sippel, and David F Schneider.
    • University of California, Irvine School of Medicine, Irvine, CA. Electronic address: delfenbe@uci.edu.
    • J. Am. Coll. Surg. 2016 Jan 1; 222 (1): 83-8.

    BackgroundWeight-based postoperative levothyroxine (LT4) dosing often fails to appropriately dose overweight and underweight patients. Previously, we created an LT4-dosing algorithm based on BMI. We hypothesize that more patients will achieve euthyroidism at their postoperative visit with the use of the protocol.Study DesignA prospective evaluation was performed of our previously published BMI-based LT4 dosing. All adults who underwent thyroidectomy for benign disease between January 1, 2011 and December 31, 2013 were included; the new protocol was implemented in October 2012. Serum TSH was measured for all patients 6 to 8 weeks postoperatively, and adjustments were based on TSH.ResultsThree hundred and thirty patients were included, with 54% undergoing thyroidectomy after institution of the protocol. The groups were well matched. Before protocol implementation, LT4 was dosed solely by weight and 25% of patients were euthyroid at initial follow-up. After the protocol, 39% of patients were euthyroid (p = 0.01). The percentage of patients who were given too high a dose of LT4 remained the same (46% vs 42%), and there was a significant reduction in the number of patients who were given too little (29% vs 19%; p = 0.05). The effect was most profound in patients with low and normal BMI, and there were slight differences between sexes.ConclusionsAlthough correct initial dosing of LT4 remains challenging, this dosing protocol that we developed and implemented has improved patient care by increasing the number of patients who achieve euthyroidism at the first postoperative visit. We have made a change to our original protocol to incorporate sex differences into the calculation.Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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