{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:51:18Z","timestamp":1791827478230,"version":"4.3.4"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Endocrine"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Dosing levothyroxine (LT4) in athyreotic patients after total thyroidectomy may appear straightforward to manage. However, robust evidence to guide therapy remains lacking. This study aimed to provide further information on the efficacy of fixed, weight-adjusted LT4 dosing initiated immediately after surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials<\/jats:title>\n                    <jats:p>Consecutive patients were enrolled at a single institution applying a standardized postoperative protocol: all cases initiated LT4 therapy immediately postoperatively at dose of ~1.6\u2009mcg\/kg, undergo their thyroid function test after six weeks, and receive subsequent dose adjustments until the target is reached.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Forty-eight patients met the inclusion criteria. The median LT4 starting dose was 100\u2009mcg per day and 1.56\u2009mcg\/kg of body weight per day. At the first follow-up, 16 (33.3%) patients were at target. Over follow-up, the overall median time-to-target was 4 months. The 32 patients who reached the target later included 15 patients showing a decreased LT4 requirement and 17 patients with an increased LT4 need. The correlation analysis between body weight and LT4 dose revealed significant negative association between LT4 dose and weight variation (R\u00b2 0.18). In the multiple linear regression body weight and comorbidities were positively associated with LT4 dose on target, while age showed a negative association.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Early postoperative weight changes influence significantly LT4 dose requirements, and age and comorbidities provided additional predictive value. These findings highlight the need for early follow-up and LT4 titration in patients not at target after initial evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12020-026-04610-x","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T06:17:30Z","timestamp":1777270650000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The effectiveness of levothyroxine starting doses after thyroidectomy is compromised by early body variations occurring after surgery"],"prefix":"10.1007","volume":"91","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2125-4937","authenticated-orcid":false,"given":"Pierpaolo","family":"Trimboli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Giacopelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Zandon\u00e0","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Verdiana","family":"Caironi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0678-3240","authenticated-orcid":false,"given":"Chiara","family":"Camponovo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0483-7126","authenticated-orcid":false,"given":"Elena","family":"Gamarra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4226-4131","authenticated-orcid":false,"given":"Lauro","family":"Gianola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Lucchini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0661-1649","authenticated-orcid":false,"given":"Marco","family":"Centanni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6464-2334","authenticated-orcid":false,"given":"Mario","family":"Rotondi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4973-1950","authenticated-orcid":false,"given":"Camilla","family":"Virili","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4252-4630","authenticated-orcid":false,"given":"Petra","family":"Makovac","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"4610_CR1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.694325","volume":"12","author":"A Crafa","year":"2021","unstructured":"A. Crafa, A.E. Calogero, R. Cannarella, L.M. Mongioi\u2019, R.A. Condorelli, E.A. Greco, A. Aversa, S. La Vignera, The burden of hormonal disorders: A worldwide overview with a particular look in Italy. Front Endocrinol (Lausanne) 12, 694325 (2021). https:\/\/doi.org\/10.3389\/fendo.2021.694325","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"Suppl 2","key":"4610_CR2","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1007\/s12325-019-01078-2","volume":"36","author":"LH Duntas","year":"2019","unstructured":"L.H. Duntas, J. Jonklaas, Levothyroxine dose adjustment to optimise therapy throughout a patient\u2019s lifetime. Adv Ther 36(Suppl 2), 30\u201346 (2019). https:\/\/doi.org\/10.1007\/s12325-019-01078-2","journal-title":"Adv Ther"},{"issue":"3","key":"4610_CR3","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1210\/er.2013-1083","volume":"35","author":"B Biondi","year":"2014","unstructured":"B. Biondi, L. Wartofsky, Treatment with thyroid hormone. Endocr Rev 35(3), 433\u2013512 (2014). https:\/\/doi.org\/10.1210\/er.2013-1083","journal-title":"Endocr Rev"},{"issue":"12","key":"4610_CR4","doi-asserted-by":"publisher","first-page":"1670","DOI":"10.1089\/thy.2014.0028","volume":"24","author":"J Jonklaas","year":"2014","unstructured":"J. Jonklaas, A.C. Bianco, A.J. Bauer, K.D. Burman, A.R. Cappola, F.S. Celi, D.S. Cooper, B.W. Kim, R.P. Peeters, M.S. Rosenthal, A.M. Sawka; American Thyroid Association Task Force on Thyroid Hormone Replacement, Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid 24(12), 1670\u20131751 (2014). https:\/\/doi.org\/10.1089\/thy.2014.0028","journal-title":"Thyroid"},{"key":"4610_CR5","doi-asserted-by":"publisher","unstructured":"Centanni M., Duntas L., Feldt-Rasmussen U., Koehrle J., Peeters R. P., Razvi S., Trimboli P., Virili C. ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism. Eur Thyroid J. 2025:ETJ-25-0123. https:\/\/doi.org\/10.1530\/ETJ-25-0123.","DOI":"10.1530\/ETJ-25-0123"},{"issue":"1","key":"4610_CR6","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1002\/bjs.5157","volume":"93","author":"O Olubowale","year":"2006","unstructured":"O. Olubowale, D.R. Chadwick, Optimization of thyroxine replacement therapy after total or near-total thyroidectomy for benign thyroid disease. Br J Surg 93(1), 57\u201360 (2006). https:\/\/doi.org\/10.1002\/bjs.5157","journal-title":"Br J Surg"},{"issue":"1","key":"4610_CR7","doi-asserted-by":"publisher","first-page":"53","DOI":"10.7326\/0003-4819-96-1-53","volume":"96","author":"RL Rosenbaum","year":"1982","unstructured":"R.L. Rosenbaum, U.S. Barzel, Levothyroxine replacement dose for primary hypothyroidism decreases with age. Ann Intern Med 96(1), 53\u201355 (1982). https:\/\/doi.org\/10.7326\/0003-4819-96-1-53","journal-title":"Ann Intern Med"},{"issue":"3","key":"4610_CR8","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1111\/j.1365-2265.2010.03940.x","volume":"74","author":"D Mistry","year":"2011","unstructured":"D. Mistry, S. Atkin, H. Atkinson, S. Gunasekaran, D. Sylvester, A.S. Rigby, R.J. England, Predicting thyroxine requirements following total thyroidectomy. Clin Endocrinol (Oxf) 74(3), 384\u2013387 (2011). https:\/\/doi.org\/10.1111\/j.1365-2265.2010.03940.x","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"1","key":"4610_CR9","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.surg.2018.04.097","volume":"165","author":"NA Zaborek","year":"2019","unstructured":"N.A. Zaborek, A. Cheng, J.R. Imbus, K.L. Long, S.C. Pitt, R.S. Sippel, D.F. Schneider, The optimal dosing scheme for levothyroxine after thyroidectomy: A comprehensive comparison and evaluation. Surgery 165(1), 92\u201398 (2019). https:\/\/doi.org\/10.1016\/j.surg.2018.04.097. Epub 2018 Nov 6. Erratum in: Surgery. 2022 Jul;172(1):477. doi: 10.1016\/j.surg.2022.04.014. PMID: 30413325; PMCID: PMC6289766.","journal-title":"Surgery"},{"issue":"12","key":"4610_CR10","doi-asserted-by":"publisher","first-page":"1759","DOI":"10.1089\/thy.2014.0111","volume":"24","author":"V Di Donna","year":"2014","unstructured":"V. Di Donna, M.G. Santoro, C. de Waure, M.P. Ricciato, R.M. Paragliola, A. Pontecorvi, S.M. Corsello, A new strategy to estimate levothyroxine requirement after total thyroidectomy for benign thyroid disease. Thyroid 24(12), 1759\u20131764 (2014). https:\/\/doi.org\/10.1089\/thy.2014.0111","journal-title":"Thyroid"},{"key":"4610_CR11","doi-asserted-by":"publisher","unstructured":"Chiardi I., Croce L., Caccavale P., Bertini J., Coperchini F., Magri F., Cappelli C., Trimboli P., Rotondi M. Establishing the adequate levothyroxine dose after total thyroidectomy: A systematic review with meta-analysis. J Clin Endocrinol Metab. 2025:dgaf417. https:\/\/doi.org\/10.1210\/clinem\/dgaf417.","DOI":"10.1210\/clinem\/dgaf417"},{"issue":"1","key":"4610_CR12","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1007\/s12020-019-02049-x","volume":"66","author":"C Virili","year":"2019","unstructured":"C. Virili, P. Trimboli, M. Centanni, Novel thyroxine formulations: a further step toward precision medicine. Endocrine 66(1), 87\u201394 (2019). https:\/\/doi.org\/10.1007\/s12020-019-02049-x","journal-title":"Endocrine"},{"issue":"9596","key":"4610_CR13","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","volume":"370","author":"E von Elm","year":"2007","unstructured":"E. von Elm, D.G. Altman, M. Egger, S.J. Pocock, P.C. G\u00f8tzsche, J.P. Vandenbroucke; STROBE Initiative, The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370(9596), 1453\u20131457 (2007). https:\/\/doi.org\/10.1016\/S0140-6736(07)61602-X","journal-title":"Lancet"},{"issue":"2","key":"4610_CR14","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1007\/s12020-023-03460-1","volume":"84","author":"U Feldt-Rasmussen","year":"2024","unstructured":"U. Feldt-Rasmussen, G. Effraimidis, S. Bliddal, M. Klose, Consequences of undertreatment of hypothyroidism. Endocrine 84(2), 301\u2013308 (2024). https:\/\/doi.org\/10.1007\/s12020-023-03460-1","journal-title":"Endocrine"},{"issue":"11","key":"4610_CR15","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.4158\/EP14125.OR","volume":"20","author":"M Rotondi","year":"2014","unstructured":"M. Rotondi, L. Croce, C. Pallavicini, L.L. Manna, S.M. Accornero, R. Fonte, F. Magri, L. Chiovato, Body weight changes in a large cohort of patients subjected to thyroidectomy for a wide spectrum of thyroid diseases. Endocr Pract 20(11), 1151\u20131158 (2014). https:\/\/doi.org\/10.4158\/EP14125.OR","journal-title":"Endocr Pract"},{"issue":"1","key":"4610_CR16","doi-asserted-by":"publisher","first-page":"239","DOI":"10.3390\/biomedicines12010239","volume":"12","author":"T Piticchio","year":"2024","unstructured":"T. Piticchio, F. Savarino, S. Volpe, A. Prinzi, G. Costanzo, E. Gamarra, F. Frasca, P. Trimboli, Inflammatory profile assessment in a highly selected athyreotic population undergoing controlled and standardized hypothyroidism. Biomedicines 12(1), 239 (2024). https:\/\/doi.org\/10.3390\/biomedicines12010239","journal-title":"Biomedicines"},{"issue":"1","key":"4610_CR17","doi-asserted-by":"publisher","first-page":"71","DOI":"10.4158\/EP09257.OR","volume":"16","author":"J Jonklaas","year":"2010","unstructured":"J. Jonklaas, Sex and age differences in levothyroxine dosage requirement. Endocr Pract 16(1), 71\u201379 (2010). https:\/\/doi.org\/10.4158\/EP09257.OR","journal-title":"Endocr Pract"},{"issue":"6","key":"4610_CR18","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1016\/S2213-8587(18)30371-1","volume":"7","author":"J Jonklaas","year":"2019","unstructured":"J. Jonklaas, S. Razvi, Reference intervals in the diagnosis of thyroid dysfunction: treating patients not numbers. Lancet Diabetes Endocrinol 7(6), 473\u2013483 (2019). https:\/\/doi.org\/10.1016\/S2213-8587(18)30371-1","journal-title":"Lancet Diabetes Endocrinol"}],"container-title":["Endocrine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12020-026-04610-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12020-026-04610-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12020-026-04610-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:28:29Z","timestamp":1791826109000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12020-026-04610-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,27]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4610"],"URL":"https:\/\/doi.org\/10.1007\/s12020-026-04610-x","relation":{},"ISSN":["1559-0100"],"issn-type":[{"value":"1559-0100","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,27]]},"assertion":[{"value":"30 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 October 2026","order":5,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Update","order":6,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This article was originally published under the subscription model but it is now published under an Open Access license.","order":7,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Pierpaolo Trimboli and Camilla Virili served in the past as clinical consultant for IBSA Institut Biochimique SA. The other authors have no competing interests to declare relevant to the content of this article.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This retrospective study was approved by local Ethics Committee. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.","order":2,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Informed consent was obtained from all subjects involved in the study according to the protocol approved by Ethics Committee.","order":3,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"140"}}