Compliance to levothyroxine treatment of the patients with hypothyroidism during SARS-CoV-2 pandemic era

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Satilmis Bilgin
Burcin Meryem Atak Tel
Tuba Taslamacioglu Duman
Ozge Kurtkulagi
Gizem Bakir Kahveci
Tugrul Sagdic
Gulali Aktas


Background. Hypothyroidism requires treatment with levothyroxine (L-T4) to keep patients euthyroid. The rate of hospital admissions for chronic conditions decreased during COVID-19 era. We aimed to observe whether hospital admissions of the patients with hypothyroidism decreased during COVID-19 compared to the same time period in 2019. We also aimed to find out the rate of treatment compliance in subjects with hypothyroidism during pandemic era. Materials and methods. This cross-sectional study was performed on patients who applied to Internal Medicine Department of Abant Izzet Baysal University Hospital, and who received L-T4 replacement therapy due to hypothyroidism. 108 hypothyroidism patients were included in the study with their consent forms. The patients were divided into 2 groups according to the treatment compliance; either as compliant or incompliant patients. Results. The last TSH level of compliant group was significantly lower than incompliant group (p < 0.001). The last fT4 level of the compliant group was significantly higher than that of the incompliant group (p = 0.04). The median of the LT-4 treatment used irregularly was 35 (10–90) days in incompliant group and was 0 (0–0) days in compliant group (p < 0.001). The number of irregularly L-T4 used days was significantly positively correlated with last TSH value (r = 0.564, p < 0.001), and negatively correlated with last FT4 value (r = –0.492, p < 0.001). Mean corpuscular volume (MCV) of the compliant and incompliant groups were 85 (69.1–97.5) fL and 89 (66–96.6) fL, respectively (p = 0.03). Retrospective nature and relatively small study population are two main limitations of our study. Conclusions. Compliance to treatment is very important to achieve euthyroid hormone levels in patients with hypothyroidism during COVID-19 pandemic. Elevated MCV levels could predict incompliance to treatment in hypothyroidism.

Article Details

How to Cite
Bilgin, S., B. Meryem Atak Tel, T. Taslamacioglu Duman, O. Kurtkulagi, G. Bakir Kahveci, T. Sagdic, and G. Aktas. “Compliance to Levothyroxine Treatment of the Patients With Hypothyroidism During SARS-CoV-2 Pandemic Era”. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine), vol. 17, no. 2, May 2021, pp. 103-7, doi:10.22141/2224-0721.17.2.2021.230563.
Original Researches


McDermott MT. Hypothyroidism. Ann Intern Med. 2020 Jul 7;173(1):ITC1-ITC16. doi:10.7326/AITC202007070.

Garber JR, Cobin RH, Gharib H, et al; American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012 Nov-Dec;18(6):988-1028. doi:10.4158/EP12280.GL.

Cooper DS, Biondi B. Subclinical thyroid disease. Lancet. 2012 Mar 24;379(9821):1142-54. doi:10.1016/S0140-6736(11)60276-6.

Leng O, Razvi S. Hypothyroidism in the older population. Thyroid Res. 2019 Feb 8;12:2. doi:10.1186/s13044-019-0063-3.

Ingoe L, Phipps N, Armstrong G, Rajagopal A, Kamali F, Razvi S. Prevalence of treated hypothyroidism in the community: Analysis from general practices in North-East England with implications for the United Kingdom. Clin Endocrinol (Oxf). 2017 Dec;87(6):860-864. doi:10.1111/cen.13440.

Brown SJ, Bremner AP, Hadlow NC, et al. The log TSH-free T4 relationship in a community-based cohort is nonlinear and is influenced by age, smoking and thyroid peroxidase antibody status. Clin Endocrinol (Oxf). 2016 Nov;85(5):789-796. doi:10.1111/cen.13107.

Razvi S, Bhana S, Mrabeti S. Challenges in Interpreting Thyroid Stimulating Hormone Results in the Diagnosis of Thyroid Dysfunction. J Thyroid Res. 2019 Sep 22;2019:4106816. doi:10.1155/2019/4106816.

Fitzgerald SP, Bean NG. Thyroid stimulating hormone (TSH) autoregulation reduces variation in the TSH response to thyroid hormones. Temperature (Austin). 2018 Oct 8;5(4):380-389. doi:10.1080/23328940.2018.1513110.

Hennessey JV, Espaillat R. Current evidence for the treatment of hypothyroidism with levothyroxine/levotriiodothyronine combination therapy versus levothyroxine monotherapy. Int J Clin Pract. 2018 Feb;72(2):e13062. doi:10.1111/ijcp.13062.

Jonklaas J, Bianco AC, Bauer AJ, et al; American Thyroid Association Task Force on Thyroid Hormone Replacement. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid. 2014 Dec;24(12):1670-751. doi:10.1089/thy.2014.0028.

Taylor PN, Razvi S, Pearce SH, Dayan CM. Clinical review: A review of the clinical consequences of variation in thyroid function within the reference range. J Clin Endocrinol Metab. 2013 Sep;98(9):3562-71. doi:10.1210/jc.2013-1315.

Biondi B. The normal TSH reference range: what has changed in the last decade? J Clin Endocrinol Metab. 2013 Sep;98(9):3584-7. doi:10.1210/jc.2013-2760.

Cerqueira C, Knudsen N, Ovesen L, et al. Doubling in the use of thyroid hormone replacement therapy in Denmark: association to iodization of salt? Eur J Epidemiol. 2011 Aug;26(8):629-35. doi:10.1007/s10654-011-9590-5.

Hoermann R, Midgley JE. TSH Measurement and Its Implications for Personalised Clinical Decision-Making. J Thyroid Res. 2012;2012:438037. doi:10.1155/2012/438037.

Chen Y, Tai HY. Levothyroxine in the treatment of overt or subclinical hypothyroidism: a systematic review and meta-analysis. Endocr J. 2020 Jul 28;67(7):719-732. doi:10.1507/endocrj.EJ19-0583.

De Filippo O, D'Ascenzo F, Angelini F, et al. Reduced Rate of Hospital Admissions for ACS during Covid-19 Outbreak in Northern Italy. N Engl J Med. 2020 Jul 2;383(1):88-89. doi:10.1056/NEJMc2009166.

Mafham MM, Spata E, Goldacre R, et al. COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England. Lancet. 2020 Aug 8;396(10248):381-389. doi:10.1016/S0140-6736(20)31356-8.

Zhang Y, Wen J, Alamgir M, et al. Impact of the COVID-19 pandemic on inpatient dermatology: a multicentre study from Hubei, China. J Eur Acad Dermatol Venereol. 2021 Mar;35(3):e179-e181. doi:10.1111/jdv.17041.

Silva AB, Freschi G, Carrera RV, et al. COVID-19 pandemic impact on clinical outcomes of patients with obstructive pyelonephritis. Int Urol Nephrol. 2021 Apr;53(4):627-633. doi:10.1007/s11255-020-02708-3.

Nef HM, Elsässer A, Möllmann H, et al; CoVCAD –Study Group. Impact of the COVID-19 pandemic on cardiovascular mortality and catherization activity during the lockdown in central Germany: an observational study. Clin Res Cardiol. 2021 Feb;110(2):292-301. doi:10.1007/s00392-020-01780-0.

Stöhr E, Aksoy A, Campbell M, et al. Hospital admissions during Covid-19 lock-down in Germany: Differences in discretionary and unavoidable cardiovascular events. PLoS One. 2020 Nov 20;15(11):e0242653. doi:10.1371/journal.pone.0242653.

Karia M, Gupta V, Zahra W, Dixon J, Tayton E. The effect of COVID-19 on the trauma burden, theatre efficiency and training opportunities in a district general hospital: planning for a future outbreak. Bone Jt Open. 2020 Aug 18;1(8):494-499. doi:10.1302/2633-1462.18.BJO-2020-0074.R1.

Fahy S, Moore J, Kelly M, Flannery O, Kenny P. Analysing the variation in volume and nature of trauma presentations during COVID-19 lockdown in Ireland. Bone Jt Open. 2020 Nov 1;1(6):261-266. doi:10.1302/2046-3758.16.BJO-2020-0040.R1.

Grech V, Borg D, Agius S, Scherb H. WITHDRAWN: Sharp decline in acute and elective hospital attendances and admissions due to COVID-19 in Malta (Q1 2020) - A population-based study. Early Hum Dev. 2020 Nov 12:105250. doi:10.1016/j.earlhumdev.2020.105250.

Atik F, Aktas G, Kocak MZ, Erkus E, Savli H. Analysis of the Factors Related to the Blood Pressure Control in Hypertension. J Coll Physicians Surg Pak. 2018 Jun;28(6):423-426. doi:10.29271/jcpsp.2018.06.423.

Erdogan M, Kösenli A, Ganidagli S, Kulaksizoglu M. Characteristics of anemia in subclinical and overt hypothyroid patients. Endocr J. 2012;59(3):213-20. doi:10.1507/endocrj.ej11-0096.

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