In the treatment of hypothyroidism, thyroid-stimulating hormone (TSH) and thyroid hormones are measured and the levothyroxine dose is adjusted in order to achieve a euthyroid state. The initial dose is calculated according to weight, but other factors can influence the dose required to stabilize TSH.
Objective: To estimate the percentage of patients who achieve good control of TSH over a 4-year follow-up period; to assess the factors associated with TSH instability.
Design: Retrospective population-based cohort study of patients treated for hypothyroidism in a health region in Catalonia, Spain (2010-2014). The data were obtained from the pharmacy drug dispensation register included in the computerized medical records of the regional health system.
Setting: Lleida health region (Catalonia, Spain).
Participants: All patients who had an initial normal TSH value (0.27-5.0 mU/L) or had received levothyroxine were selected.
Main measurements: The variables analyzed were: TSH values during follow-up, estimated time with normal TSH, age, sex, body mass index, and compliance with treatment.
Results: Of the 2,630 patients with hypothyroidism, 90.3% were women. Mean age was 59.6 years and the treatment compliance rate 84.9%. Patients taking a medium dose of levothyroxine (75-125 mcg) and older patients had higher TSH stability and maintained normal TSH levels for longer (p<0.05).
Conclusions: A fifth of patients with hypothyroidism had inadequate thyroid hormone replacement in the first year. Factors associated with TSH stability were levothyroxine dose in the medium range and older age.
Ortega Bravo Marta
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