Clinical determinants of levothyroxine dosage adjusted for various body weights
Main Article Content
Keywords
Thyroid Gland, Hypothyroidism, Thyroxine, Body Weight
Abstract
Abstract
Background: Hypothyroidism requires treatment with levothyroxine to achieve a euthyroid state. Dosage based solely on body weight has limitations, particularly in patients with overweight or obesity.
Objective: To evaluate whether the levothyroxine dose required to achieve a euthyroid state, adjusted for different body weight measures, varies according to sex, age, body mass index (BMI), and type of hypothyroidism.
Material and methods: An analytical cross-sectional study was conducted in euthyroid adults with hypothyroidism receiving levothyroxine therapy between August 2024 and August 2025. Patients with recent dose adjustments or conditions affecting drug absorption were excluded. Absolute doses and doses adjusted for actual body weight, ideal body weight, adjusted body weight, and fat-free mass were analyzed.
Results: A total of 101 patients were included; 76.2% were women and 23.8% men, with a mean age of 50.8 ± 14.9 years. Women received higher levothyroxine doses adjusted for ideal body weight and fat‑free mass than men. Overweight and obese patients received higher total doses and higher ideal weight‑adjusted doses than patients with normal BMI. No differences were observed in levothyroxine dose adjusted for any body weight for age or type of hypothyroidism.
Conclusions: Sex influences levothyroxine doses adjusted for ideal body weight and fat‑free mass, while BMI status influences total and ideal weight‑adjusted doses.
References
1. Taylor PN, Medici MM, Hubalewska-Dydejczyk A, et al. Hypothyroidism. Lancet. 2024;404(10460):1347-64. doi: 10.1016/S0140-6736(24)01614-3
2. Zamwar UM, Muneshwar KN. Epidemiology, Types, Causes, Clinical Presentation, Diagnosis, and Treatment of Hypothyroidism. Cureus. 2023;15(9):e46241. doi: 10.7759/cureus.46241
3. Chaker L, Razvi S, Bensenor IM, et al. Hypothyroidism. Nat Rev Dis Primer. 2022;8(1):30. doi: 10.1038/s41572-022-00357-7
4. Hughes K, Eastman C. Thyroid disease: Long-term management of hyperthyroidism and hypothyroidism. Aust J Gen Pract. 2021;50(1-2):36-42. doi: 10.31128/AJGP-09-20-5653
5. Ettleson MD, Papaleontiou M. Evaluating health outcomes in the treatment of hypothyroidism. Front Endocrinol. 2022;13:1026262. doi: 10.3389/fendo.2022.1026262
6. Wilson SA, Stem LA, Bruehlman RD. Hypothyroidism: Diagnosis and Treatment. Am Fam Physician. 2021;103(10):605-13.
7. Gottwald-Hostalek U, Kahaly GJ. Triiodothyronine alongside levothyroxine in the management of hypothyroidism? Curr Med Res Opin. 2021;37(12):2099-106. doi: 10.1080/03007995.2021.1984219
8. Jonklaas J, Bianco AC, Bauer AJ, 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. doi: 10.1089/thy.2014.0028
9. Brenta G, Vaisman M, Sgarbi JA, et al. Clinical practice guidelines for the management of hypothyroidism. Arq Bras Endocrinol Metabol. 2013;57(4):265-91. doi: 10.1590/s0004-27302013000400003
10. Alaeddin N, Jongejan RMS, Stingl JC, et al. Over- and Undertreatment With Levothyroxine. Dtsch Ärztebl Int. 2023;120(42):711-8. doi: 10.3238/arztebl.m2023.0192
11. Nair A, Chellamma J, Gopi A, et al. Efficacy of a levothyroxine dosage regimen based on serum thyrotropin level, for primary hypothyroidism. An open label dose finding study. J Fam Med Prim Care. 2024;13(1):70-6. doi: 10.4103/jfmpc.jfmpc_654_23
12. Caron P, Grunenwald S, Persani L, et al. Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults. Rev Endocr Metab Disord. 2022;23(3):463-83. doi: 10.1007/s11154-021-09691-9
13. Stempler M, Bakos B, Solymosi T, et al. Analysis of factors influencing the dose of levothyroxine treatment in adequately controlled hypothyroid patients of different etiologies. Heliyon. 2024;10(20):e39639. doi: 10.1016/j.heliyon.2024.e39639
14. Venkateswarlu D, Goroshi M, Ganakumar V, et al. Lean Body Mass as a Predictor of Levothyroxine Requirement in Primary Hypothyroidism as Compared to Actual Body Weight. J Endocr Soc. 2025;9(12):bvaf159. doi: 10.1210/jendso/bvaf159
15. Centanni M, Duntas L, Feldt-Rasmussen U, et al. ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism. Eur Thyroid J. 2025;14(4):e250123. doi: 10.1530/ETJ-25-0123
16. Devine BJ. Gentamicin therapy. Drug Intell Clin Pharm. 1974;8:650-5.
17. Pai MP, Paloucek FP. The origin of the «ideal» body weight equations. Ann Pharmacother. 2000;34(9):1066-9. doi: 10.1345/aph.19381
18. Janmahasatian S, Duffull SB, Ash S, et al. Quantification of lean bodyweight. Clin Pharmacokinet. 2005;44(10):1051-65. doi: 10.2165/00003088-200544100-00004
19. La Colla L, Albertin A, La Colla G, et al. Predictive performance of the «Minto» remifentanil pharmacokinetic parameter set in morbidly obese patients ensuing from a new method for calculating lean body mass. Clin Pharmacokinet. 2010;49(2):131-9. doi: 10.2165/11317690-000000000-00000
20. Mathiphanit S, Yenseung N, Chatchomchuan W, et al. Profile of Levothyroxine Replacement Therapy in Graves’ Disease Patients with Hypothyroidism Post-Radioactive Iodine Ablation: Focus on Different Weight-Based Regimens. J ASEAN Fed Endocr Soc. 2022;37(1):62-8. doi: 10.15605/jafes.037.01.19
21. Dawn Paul E, T-V S, Sulaiman SV. Optimizing Thyroxine Dosage After Total Thyroidectomy: Understanding the Factors at Play. Cureus. 2024;16(4):e58430. doi: 10.7759/cureus.58430
22. Pustilnik E, Schwarzstein D, Feldman R, et al. The influence of age and body weight on levothyroxine replacement dosage to achieve euthyroidism in patients with primary hypothyroidism. Endocrinol Diabetes Nutr. 2021;68(8):542-7. doi: 10.1016/j.endien.2021.11.014
23. Gavigan C, Abbey EJ, McGready J, et al. Levothyroxine Dosing in Older Adults: Recommendations Derived From The Baltimore Longitudinal Study of Aging. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 2023;29(8):612-7. doi: 10.1016/j.eprac.2023.05.002
24. Effraimidis G, Watt T, Feldt-Rasmussen U. Levothyroxine Therapy in Elderly Patients With Hypothyroidism. Front Endocrinol. 2021;12:641560. doi: 10.3389/fendo.2021.641560
25. Raashid K, Ishtiaq O, Kamin M, et al. Weight and Body Mass Index for Predicting Thyroxine Dose in Primary Hypothyroidism. Cureus. 2021;13(5):e15031. doi: 10.7759/cureus.15031
26. Ratanapornsompong G, Sriphrapradang C. Appropriate dose of levothyroxine replacement therapy for hypothyroid obese patients. J Clin Transl Endocrinol. 2021;25:100264. doi: 10.1016/j.jcte.2021.100264
27. Ramírez Stieben LA, Pustilnik E, Feldman R, et al. Optimal levothyroxine dose to achieve euthyroidism in patients with primary hypothyroidism: analysis according to etiology. Rev Fac Cienc Médicas Córdoba. 2022;79(4):353-7. doi: 10.31053/1853.0605.v79.n4.35157
28. Şen Uzeli Ü, Tutan D. Influence of Lean Body Mass and Disease Etiology on Levothyroxine Requirements in Patients with Hypothyroidism. Hitit Med J. 2025;7(3):386-93. doi: 10.52827/hititmedj.1705311
29. Singh R. Does One Size Fit Everyone? Replacement Dose of Levothyroxine in Long-standing Primary Hypothyroidism in Adults. Indian J Endocrinol Metab. 2017;21(3):404-9. doi: 10.4103/ijem.IJEM_502_16
30. Glymph K, Gosmanov AR. Levothyroxine replacement in obese hypothyroid females after total thyroidectomy. Endocr Pract. 2016;22(1):22-9. doi: 10.4158/EP15836.OR
31. Jonklaas J. Optimal Thyroid Hormone Replacement. Endocr Rev. 2022;43(2):366-404. doi: 10.1210/endrev/bnab031
