Rossi Leonardo, Paternoster Marinunzia, Cammarata Mattia, Bakkar Sohail, Miccoli Paolo
Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy.
Department of Surgery, Faculty of Medicine, The Hashemite University, Zarqa, Jordan.
Front Endocrinol (Lausanne). 2025 May 26;16:1582734. doi: 10.3389/fendo.2025.1582734. eCollection 2025.
This mini-review provides an update on the challenges and controversies surrounding levothyroxine therapy in thyroidectomized patients, following an extensive review on dosing strategies and available formulations. Despite efforts to establish an ideal dosage adjustment method, achieving optimal thyroid hormone replacement remains complex due to interindividual variations in the hypothalamic-pituitary-thyroid axis and the pharmacokinetic and pharmacodynamic limitations of exogenous levothyroxine. Additionally, this review highlights the importance of evaluating the risk-benefit ratio of levothyroxine therapy, particularly in the setting of TSH suppression, focusing on its effects on quality of life, bone metabolism, and cardiac rhythm. Levothyroxine-induced subclinical hyperthyroidism may contribute to an increased risk of atrial fibrillation and alterations in bone mineral density, with implications that remain a subject of debate. Given the incomplete replication of endogenous thyroid hormone action by levothyroxine monotherapy, a tailored therapeutic approach is crucial. Despite ongoing research, the optimal management of thyroidectomized patients continues to be an open issue.
在对甲状腺切除患者左甲状腺素治疗的给药策略和可用制剂进行广泛综述之后，本综述提供了有关左甲状腺素治疗所面临的挑战和争议的最新情况。尽管人们努力建立理想的剂量调整方法，但由于下丘脑-垂体-甲状腺轴的个体差异以及外源性左甲状腺素的药代动力学和药效学限制，实现最佳甲状腺激素替代治疗仍然很复杂。此外，本综述强调了评估左甲状腺素治疗风险效益比的重要性，特别是在促甲状腺激素（TSH）抑制的情况下，重点关注其对生活质量、骨代谢和心律的影响。左甲状腺素引起的亚临床甲状腺功能亢进可能会增加心房颤动的风险并改变骨矿物质密度，其影响仍是一个有争议的话题。鉴于左甲状腺素单一疗法无法完全复制内源性甲状腺激素的作用，量身定制的治疗方法至关重要。尽管研究仍在进行，但甲状腺切除患者的最佳管理仍然是一个悬而未决的问题。
