Optimal Levothyroxine Dosing Strategy for Immune Checkpoint Inhibitor-related Hypothyroidism: A Retrospective Study
Authors' conclusion
LT4 requirements vary depending on the subtype of ICI-related hypothyroidism. The rapid titration strategy reduced the time to achieve a euthyroid state without a significant increase in adverse effects compared to conventional LT4 replacement therapy.
Study context
- Population
- Patients with immune checkpoint inhibitor (ICI)-related hypothyroidism, tertiary academic hospital
- Participants
- 109 patients
- Exposure
- Rapid vs conventional levothyroxine (LT4) titration strategy
- Outcome
- Time to achieve normal free thyroxine and TSH levels
Methodological detailssingle tertiary academic hospital
- Single tertiary academic hospital
Main finding
As reported in the abstract
Rapid titration vs Conventional titrationHazard ratio (95% CI)
Normal free thyroxine
4.44(2.24–8.82)
Normal TSH
4.11(2.18–7.73)
Observational data: associations, not effects.
Further findings
| Outcome | Mean difference (μg/kg/day) (95% CI) | |
|---|---|---|
| LT4 dose to achieve euthyroid state: transient thyrotoxicosis followed by overt hypothyroidismvs isolated overt hypothyroidism | 0.23 (0.08–0.38) | |
| −0.200.20.4Difference, μg/kg/day (linear scale) |
Predictive equation for LT4 dose at euthyroid state (thyrotoxicosis followed by overt hypothyroidism)
- Predicted LT4 dose (µg/kg/day)
- (−0.016 × body weight) + (0.109 × baseline TSH level) + 2.661
Safety
- Comparable safety profile of rapid vs conventional titration
Original publication
Optimal Levothyroxine Dosing Strategy for Immune Checkpoint Inhibitor-related Hypothyroidism: A Retrospective Study. J Clin Endocrinol Metab. Published 3 May 2025. doi:10.
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