Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2025
Do Levothyroxine Adjustments During Pregnancy Differ Between Users of Tablet and Nontablet Formulation? A Real-World Study.
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Scappaticcio Lorenzo, Di Martino Nicole, Ferrazzano Pamela, Di Nuzzo Michela, Volatile Alessandra, Caruso Paola, Longo Miriam, La Verde Marco, Maiorino Maria Ida, De Franciscis Pasquale, Trimboli Pierpaolo, Bellastella Giuseppe, Esposito Katherine
Аннотация
OBJECTIVE: We aimed to assess the levothyroxine (LT4) dosage needed to achieve a target thyrotropin (TSH) ≤2.5 μIU/mL in LT4 tablet and nontablet users during the first half of pregnancy.
METHODS: We conducted a retrospective analysis on pregnant women with hypothyroidism on LT4 at our university hospital over a period of 4 years. Inclusion criteria were (1) 0.5 μIU/mL < TSH < 4.0 μIU/mL after the first visit; availability of serum TSH every 30 to 40 days until midpregnancy; correct LT4 intake and compliance. Predictors of achieving TSH ≤2.5 μIU/mL were explored using a multivariable probit regression model. P value lower than .05 was considered statistically significant.
RESULTS: We included 212 pregnant women (185 with non-post-thyroidectomy hypothyroidism and 27 with post-thyroidectomy hypothyroidism) on LT4 (tablet in 132 women [62.3%], whereas nontablet in 80 women [37.7%]). In non-post-thyroidectomy hypothyroidism, the adjusted analysis, accounting for confounders (ie, maternal weight, thyroid volume, and type of hypothyroidism), revealed that both LT4 dose (P = .001) and formulation (P = .036) were independent and significant predictors of achieving the TSH target. In non-post-thyroidectomy hypothyroidism, the required dose to achieve a 90% probability of success (TSH ≤2.5 μIU/mL) was lower for the nontablet group (1.5 μg/kg/d; 95% CI: 0.47-2.62) than for the tablet group (2.4 μg/kg/d; 95% CI: 1.8-5.6).
CONCLUSION: In pregnant women with non-post-thyroidectomy hypothyroidism lower LT4 dosages may be necessary to achieve TSH between 0.5 μIU/mL < TSH ≤ 2.5 μIU/mL with LT4 nontablet compared with tablet formulations (therapeutic superiority).
METHODS: We conducted a retrospective analysis on pregnant women with hypothyroidism on LT4 at our university hospital over a period of 4 years. Inclusion criteria were (1) 0.5 μIU/mL < TSH < 4.0 μIU/mL after the first visit; availability of serum TSH every 30 to 40 days until midpregnancy; correct LT4 intake and compliance. Predictors of achieving TSH ≤2.5 μIU/mL were explored using a multivariable probit regression model. P value lower than .05 was considered statistically significant.
RESULTS: We included 212 pregnant women (185 with non-post-thyroidectomy hypothyroidism and 27 with post-thyroidectomy hypothyroidism) on LT4 (tablet in 132 women [62.3%], whereas nontablet in 80 women [37.7%]). In non-post-thyroidectomy hypothyroidism, the adjusted analysis, accounting for confounders (ie, maternal weight, thyroid volume, and type of hypothyroidism), revealed that both LT4 dose (P = .001) and formulation (P = .036) were independent and significant predictors of achieving the TSH target. In non-post-thyroidectomy hypothyroidism, the required dose to achieve a 90% probability of success (TSH ≤2.5 μIU/mL) was lower for the nontablet group (1.5 μg/kg/d; 95% CI: 0.47-2.62) than for the tablet group (2.4 μg/kg/d; 95% CI: 1.8-5.6).
CONCLUSION: In pregnant women with non-post-thyroidectomy hypothyroidism lower LT4 dosages may be necessary to achieve TSH between 0.5 μIU/mL < TSH ≤ 2.5 μIU/mL with LT4 nontablet compared with tablet formulations (therapeutic superiority).