Establishing the Adequate Levothyroxine Dose After Total Thyroidectomy: A Systematic Review With Meta-analysis
Authors' conclusion
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.
Study context
- Population
- Patients after total thyroidectomy on levothyroxine (LT4); studies published 2000–2024
- Participants
- 2,577 patients11 studies
- Comparison
- LT4 dosing strategies: fixed-dose, weight-based (dose/kg) and individualized algorithm-based
- Outcome
- Proportion of patients achieving euthyroidism
- Follow-up
- First after total thyroidectomy
Methodological detailsmeta-regression, subgroup analyses
- Meta-regression
- Subgroup analyses
Pooled result
As reported in the abstract
Euthyroidism · first follow-up
Without statistical significance
- Pooled euthyroidism rate
- 33.9%
- Heterogeneity I2
- 82.68%
Further pooled results
Predictors of euthyroidism (meta-regression)
- No statistically significant predictor identified
Euthyroidism by subgroup
- No significant differences between benign and malignant thyroid disease, or between retrospective and prospective designs
Original publication
Establishing the Adequate Levothyroxine Dose After Total Thyroidectomy: A Systematic Review With Meta-analysis. J Clin Endocrinol Metab. Published 19 July 2025. doi:10.
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