Euthyroxine dose and adjustment for thyrotropin suppression therapy For the individual patient, the euthyroxine dose for suppression therapy is the dose required to achieve his or her thyrotropin suppression goal. In patients with DTC who have cleared all of their thyroid glands, the eugenol dose for suppressive therapy is usually higher than the replacement dose alone, averaging about 1.5-2.5 μg/kg/d. In older patients (especially over 80 years old), the eugenol dose to achieve thyrotropin suppression is 20%-30% lower than in younger patients because the reduced peripheral degradation rate of thyroid hormone in older adults is greater than the reduced oral absorption rate. Zheng Shouhua, Department of General Surgery, First Affiliated Hospital of Zhengzhou University The starting dose of eugenol varies depending on the patient’s age and concomitant disease. Take the example of those whose thyroid has been completely cleared: the target dose is activated directly in young patients; in patients over 50 years old, if there is no heart disease and its tendency, the initial dose is 50μg/d; if the patient has coronary heart disease or other high-risk factors, the initial dose is 12.5 –
25μg/d or even less, with slower increments and longer adjustment intervals, and close monitoring of cardiac status. The final dose of Eugenol depends on the monitoring of serum thyrotropin. During the eugenol dose adjustment phase, thyrotropin is measured every 4 weeks or so, and thyroid function is rechecked every 2-3 months for 1 year, every 3-6 months for 2 years, and every 6-12 months for 5 years after the target is reached to make sure thyrotropin is maintained in the target range. What are the precautions for taking Eugenol orally? Eugenol is best for maintaining a stable thyrotropin level when taken on an empty stomach 1 hour before breakfast. If a dose is missed, double the dose should be taken until the entire missed dose is made up. Some patients need to adjust the dosage of Eugenol according to the change of TSH level in winter and summer (increase in winter and decrease in summer). Some special medications or foods should be taken at sufficient intervals: 1 hour between vitamins and tonic products; 2 hours between iron and calcium containing foods or medications; 4 hours between milk and soy foods; 12 hours between bilirubin or lipid-lowering resins. Thyrotropin can gradually reach steady state about 4 weeks after each adjustment of eugenol dose (longer in elderly people).