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Should We Abandon Conservative Dosage Titration?

Arch Intern Med. 2005;165:1683-1684.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Roos et al¹ compared the clinical responses in 25 patients with hypothyroidism treated with gradually incremental doses of levothyroxine, starting with 25 µg/d, with those in 25 matched patients treated from the outset with an approximate full-replacement dosage of 1.6 µg/kg per day. With no adverse sequelae in the latter group, they concluded that a full starting dose is safe, more convenient, and more cost-effective. Roos et al summarized that the rationale for the traditional practice of slowly starting levothyroxine replacement is based on the potential risks that are said to occur with higher doses, such as coronary ischemia, arrhythmia, or myocardial infarction. They refer to this traditional approach as being based on "dogma," the basis for which having never been studied prospectively. I have several concerns about their study’s conclusions and recommendations.

As support for their recommendation, Roos et al¹ refer to the use of high doses of levothyroxine . . . [Full Text of this Article]

AUTHOR INFORMATION
Leonard Wartofsky, MD, MACP

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A Change of Reason: Medicine and the Scientific Revolution
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Arch Intern Med. 2006;166(3):369-370.
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A Change of Reason: Medicine and the Scientific Revolution—Reply
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RELATED ARTICLE

The Starting Dose of Levothyroxine in Primary Hypothyroidism Treatment: A Prospective, Randomized, Double-blind Trial
Annemieke Roos, Suzanne P. Linn-Rasker, Ron T. van Domburg, Jan P. Tijssen, and Arie Berghout
Arch Intern Med. 2005;165(15):1714-1720.
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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

A change of reason: medicine and the scientific revolution.
Diskin
Arch Intern Med 2006;166:369-370.
FULL TEXT  

A Change of Reason: Medicine and the Scientific Revolution--Reply
Wartofsky
Arch Intern Med 2006;166:370-370.
FULL TEXT