Levothyroxine Treatment and the Risk of Cardiac Arrhythmias – Focus on the Patient Submitted to Thyroid Surgery

Levothyroxine (LT4) is used to treat frequently encountered endocrinopathies such as thyroid diseases. It is regularly used in clinical (overt) hypothyroidism cases and subclinical (latent) hypothyroidism cases in the last decade. Suppressive LT4 therapy is also part of the medical regimen used to m...

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Autores principales:	Zoran Gluvic, Milan Obradovic, Alan J. Stewart, Magbubah Essack, Samantha J. Pitt, Vladimir Samardzic, Sanja Soskic, Takashi Gojobori, Esma R. Isenovic
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	levothyroxine thyroid hypothyroidism cardiac arrhythmias osteoporosis replacement therapy Diseases of the endocrine glands. Clinical endocrinology RC648-665
Acceso en línea:	https://doaj.org/article/c34ef66b31284d24af057796d44a0847
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spelling	oai:doaj.org-article:c34ef66b31284d24af057796d44a08472021-11-04T08:43:40ZLevothyroxine Treatment and the Risk of Cardiac Arrhythmias – Focus on the Patient Submitted to Thyroid Surgery1664-239210.3389/fendo.2021.758043https://doaj.org/article/c34ef66b31284d24af057796d44a08472021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fendo.2021.758043/fullhttps://doaj.org/toc/1664-2392Levothyroxine (LT4) is used to treat frequently encountered endocrinopathies such as thyroid diseases. It is regularly used in clinical (overt) hypothyroidism cases and subclinical (latent) hypothyroidism cases in the last decade. Suppressive LT4 therapy is also part of the medical regimen used to manage thyroid malignancies after a thyroidectomy. LT4 treatment possesses dual effects: substituting new-onset thyroid hormone deficiency and suppressing the local and distant malignancy spreading in cancer. It is the practice to administer LT4 in less-than-high suppressive doses for growth control of thyroid nodules and goiter, even in patients with preserved thyroid function. Despite its approved safety for clinical use, LT4 can sometimes induce side-effects, more often recorded with patients under treatment with LT4 suppressive doses than in unintentionally LT4-overdosed patients. Cardiac arrhythmias and the deterioration of osteoporosis are the most frequently documented side-effects of LT4 therapy. It also lowers the threshold for the onset or aggravation of cardiac arrhythmias for patients with pre-existing heart diseases. To improve the quality of life in LT4-substituted patients, clinicians often prescribe higher doses of LT4 to reach low normal TSH levels to achieve cellular euthyroidism. In such circumstances, the risk of cardiac arrhythmias, particularly atrial fibrillation, increases, and the combined use of LT4 and triiodothyronine further complicates such risk. This review summarizes the relevant available data related to LT4 suppressive treatment and the associated risk of cardiac arrhythmia.Zoran GluvicMilan ObradovicAlan J. StewartMagbubah EssackSamantha J. PittVladimir SamardzicSanja SoskicTakashi GojoboriEsma R. IsenovicFrontiers Media S.A.articlelevothyroxinethyroidhypothyroidismcardiac arrhythmiasosteoporosisreplacement therapyDiseases of the endocrine glands. Clinical endocrinologyRC648-665ENFrontiers in Endocrinology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	levothyroxine thyroid hypothyroidism cardiac arrhythmias osteoporosis replacement therapy Diseases of the endocrine glands. Clinical endocrinology RC648-665
spellingShingle	levothyroxine thyroid hypothyroidism cardiac arrhythmias osteoporosis replacement therapy Diseases of the endocrine glands. Clinical endocrinology RC648-665 Zoran Gluvic Milan Obradovic Alan J. Stewart Magbubah Essack Samantha J. Pitt Vladimir Samardzic Sanja Soskic Takashi Gojobori Esma R. Isenovic Levothyroxine Treatment and the Risk of Cardiac Arrhythmias – Focus on the Patient Submitted to Thyroid Surgery
description	Levothyroxine (LT4) is used to treat frequently encountered endocrinopathies such as thyroid diseases. It is regularly used in clinical (overt) hypothyroidism cases and subclinical (latent) hypothyroidism cases in the last decade. Suppressive LT4 therapy is also part of the medical regimen used to manage thyroid malignancies after a thyroidectomy. LT4 treatment possesses dual effects: substituting new-onset thyroid hormone deficiency and suppressing the local and distant malignancy spreading in cancer. It is the practice to administer LT4 in less-than-high suppressive doses for growth control of thyroid nodules and goiter, even in patients with preserved thyroid function. Despite its approved safety for clinical use, LT4 can sometimes induce side-effects, more often recorded with patients under treatment with LT4 suppressive doses than in unintentionally LT4-overdosed patients. Cardiac arrhythmias and the deterioration of osteoporosis are the most frequently documented side-effects of LT4 therapy. It also lowers the threshold for the onset or aggravation of cardiac arrhythmias for patients with pre-existing heart diseases. To improve the quality of life in LT4-substituted patients, clinicians often prescribe higher doses of LT4 to reach low normal TSH levels to achieve cellular euthyroidism. In such circumstances, the risk of cardiac arrhythmias, particularly atrial fibrillation, increases, and the combined use of LT4 and triiodothyronine further complicates such risk. This review summarizes the relevant available data related to LT4 suppressive treatment and the associated risk of cardiac arrhythmia.
format	article
author	Zoran Gluvic Milan Obradovic Alan J. Stewart Magbubah Essack Samantha J. Pitt Vladimir Samardzic Sanja Soskic Takashi Gojobori Esma R. Isenovic
author_facet	Zoran Gluvic Milan Obradovic Alan J. Stewart Magbubah Essack Samantha J. Pitt Vladimir Samardzic Sanja Soskic Takashi Gojobori Esma R. Isenovic
author_sort	Zoran Gluvic
title	Levothyroxine Treatment and the Risk of Cardiac Arrhythmias – Focus on the Patient Submitted to Thyroid Surgery
title_short	Levothyroxine Treatment and the Risk of Cardiac Arrhythmias – Focus on the Patient Submitted to Thyroid Surgery
title_full	Levothyroxine Treatment and the Risk of Cardiac Arrhythmias – Focus on the Patient Submitted to Thyroid Surgery
title_fullStr	Levothyroxine Treatment and the Risk of Cardiac Arrhythmias – Focus on the Patient Submitted to Thyroid Surgery
title_full_unstemmed	Levothyroxine Treatment and the Risk of Cardiac Arrhythmias – Focus on the Patient Submitted to Thyroid Surgery
title_sort	levothyroxine treatment and the risk of cardiac arrhythmias – focus on the patient submitted to thyroid surgery
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/c34ef66b31284d24af057796d44a0847
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Levothyroxine Treatment and the Risk of Cardiac Arrhythmias – Focus on the Patient Submitted to Thyroid Surgery

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