{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T21:04:13Z","timestamp":1790888653003,"version":"4.1.0"},"reference-count":25,"publisher":"The Endocrine Society","issue":"11","license":[{"start":{"date-parts":[[2025,7,19]],"date-time":"2025-07-19T00:00:00Z","timestamp":1752883200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Recovery and Resilience Plan"},{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"publisher","award":["PE00000003"],"award-info":[{"award-number":["PE00000003"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"publisher","award":["CUP D93C22000890001"],"award-info":[{"award-number":["CUP D93C22000890001"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003196","name":"Ministry of Health Italy.","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Total thyroidectomy requires lifelong levothyroxine (LT4) therapy. Achieving optimal thyroid hormone replacement at the first postoperative follow-up might be harder than expected. Despite the various LT4 dose-choosing strategies tested, there is no consensus on the most effective approach to achieve early euthyroidism.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>We performed a systematic review and meta-analysis, including studies published between 2000 and 2024 that reported the proportion of patients achieving euthyroidism at first follow-up after total thyroidectomy. Data from 11 studies comprising 2577 patients were analyzed. LT4 dosing strategies included fixed-dose, weight-based (dose\/kg), and individualized algorithm-based methods. Meta-regression and subgroup analyses were used to explore sources of heterogeneity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The pooled euthyroidism rate at first follow-up was 33.9%, with high heterogeneity across studies (I2 = 82.68%). No dosing strategy consistently outperformed others: dose\/kg methods achieved 29% euthyroidism, while fixed or algorithm-based approaches achieved 40%, though without statistical significance. Meta-regression analysis did not identify any statistically significant predictor. No significant differences emerged between patients treated for benign or malignant thyroid diseases or between retrospective and prospective study designs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Only about one-third of patients achieve euthyroidism at first follow-up after thyroidectomy, regardless of LT4 dosing strategy. The current guidelines recommendation of applying a pro\/kg dose may not be adequate, and even personalized algorithms yield inconsistent results. Future prospective studies are needed to refine individualized dosing protocols and identify additional factors influencing LT4 requirements.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/clinem\/dgaf417","type":"journal-article","created":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T11:21:17Z","timestamp":1752837677000},"page":"3301-3308","source":"Crossref","is-referenced-by-count":6,"title":["Establishing the Adequate Levothyroxine Dose After Total Thyroidectomy: A Systematic Review With Meta-analysis"],"prefix":"10.1210","volume":"110","author":[{"given":"Isabella","family":"Chiardi","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Therapeutics, University of Pavia , Pavia 27100 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Croce","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Therapeutics, University of Pavia , Pavia 27100 ,","place":["Italy"]},{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors , Pavia 27100 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Caccavale","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Therapeutics, University of Pavia , Pavia 27100 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacopo","family":"Bertini","sequence":"additional","affiliation":[{"name":"Internal Medicine, Endocrinology and Metabolic Diseases Unit, IRCCS Ospedale Galeazzi\u2013Sant\u2019Ambrogio , Milan 173 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Coperchini","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Therapeutics, University of Pavia , Pavia 27100 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