[SPINA] Trial demonstrates SPINA-GD to be an independent predictor of L-T4 dose

[Johannes W. Dietrich]

Recently, a trial with 353 subjects on steady-state L-T4 replacement  
dose for autoimmune thyroiditis or after surgery for malignant or  
benign thyroid disease was published in Endocrine Connections.

It revealed that substitution dose was independently associated with  
gender, age, aetiology and deiodinase capacity (all p<0.001).  
Stratifying patients by deiodinase activity (SPINA-GD) categories of  
<23, 23-29 and >29 nmol/s revealed an increasing FT3-FT4 dissociation;  
the poorest converters showed the lowest FT3 levels in spite of  
highest dose and circulating FT4 (p<0.001).

As the authors state these findings imply that a) thyroid hormone  
conversion efficiency is an important modulator of the biochemical  
response to levothyroxine, b) measuring FT3 may be an additional  
treatment target, and c) L-T4 dose escalation may have limited success  
to raise FT3 appropriately in some cases.

The full text of the paper is available for free from http://dx.doi.org/10.1530%2FEC-15-0056 
  .

Reference
Midgley JE, Larisch R, Dietrich JW, Hoermann R. Variation in the  
Biochemical Response to L-Thyroxine Therapy and Relationship with  
Peripheral Thyroid Hormone Conversion. Endocr Connect. 2015 Aug 11.  
pii: EC-15-0056. [Epub ahead of print] PubMed PMID: 26265111

-- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --  
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-- Dr. med. Johannes W. Dietrich
-- Oberarzt / Consultant Endocrinologist
-- Laboratory XU44, Endocrine Research
-- Medical Hospital I, Bergmannsheil University Hospitals
-- Ruhr University of Bochum
-- Buerkle-de-la-Camp-Platz 1, D-44789 Bochum, NRW, Germany
-- Phone: +49:234:302-6400, Fax: +49:234:302-6403
-- eMail: "j.w.dietrich at medical-cybernetics.de"
-- http://www.thyreologie.com.de
-- GND 123571073 | VIAF 69838628 | Researcher ID C-3498-2009
-- ISNI: 0000 0000 1275 0811 | ORCID ID: 0000-0002-1185-3549
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