This mini-review provides an update on the challenges and controversies surrounding levothyroxine therapy in thyroidectomized patients, following an extensive review on dosing strategies and available formulations. Despite efforts to establish an ideal dosage adjustment method, achieving optimal thyroid hormone replacement remains complex due to interindividual variations in the hypothalamic-pituitary-thyroid axis and the pharmacokinetic and pharmacodynamic limitations of exogenous levothyroxine. Additionally, this review highlights the importance of evaluating the risk-benefit ratio of levothyroxine therapy, particularly in the setting of TSH suppression, focusing on its effects on quality of life, bone metabolism, and cardiac rhythm. Levothyroxine-induced subclinical hyperthyroidism may contribute to an increased risk of atrial fibrillation and alterations in bone mineral density, with implications that remain a subject of debate. Given the incomplete replication of endogenous thyroid hormone action by levothyroxine monotherapy, a tailored therapeutic approach is crucial. Despite ongoing research, the optimal management of thyroidectomized patients continues to be an open issue.

Keywords: bone risk; dose adjustment; heart risk; levothyroxine therapy; liquid levothyroxine; personalized therapy; quality of life; thyroidectomy.

Copyright © 2025 Rossi, Paternoster, Cammarata, Bakkar and Miccoli.

这篇小型综述提供了关于甲状腺切除术后左旋甲状腺素治疗面临的挑战和争议的最新信息，基于对剂量策略和可用制剂的广泛回顾。尽管努力确立理想的剂量调整方法，但由于下丘脑-垂体-甲状腺轴的个体差异以及外源性左旋甲状腺素在药代动力学和药效学上的局限性，实现最佳甲状腺激素替代治疗仍然复杂。此外，该综述强调了评估左旋甲状腺素治疗的风险收益比的重要性，特别是在抑制TSH的情况下，重点关注其对生活质量、骨代谢和心律的影响。左旋甲状腺素引起的亚临床甲亢可能增加房颤风险并改变骨矿物质密度，这些影响仍然是争论的焦点。鉴于单用左旋甲状腺素无法完全复制内源性甲状腺激素的作用，制定个性化的治疗方案至关重要。尽管正在进行研究，但甲状腺切除术后患者的最佳管理仍然是一项开放性问题。

关键词：骨风险；剂量调整；心脏风险；左旋甲状腺素治疗；液体左旋甲状腺素；个性化治疗；生活质量；甲状腺切除术。

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