LT4 and Slow Release T3 Combination: Optimum Therapy for Hypothyroidism?

Azizi, Fereidoun; Amouzegar, Atieh; Mehran, Ladan; Abdi, Hengameh

doi:10.5812/ijem.100870

Cited by 4 publications

(4 citation statements)

References 42 publications

(55 reference statements)

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“…However, the identification of patients with persistent hypothyroidism symptoms who may need a combination of L-T4 plus L-T3 is daunting due to the non-specificity of the symptoms of hypothyroidism. Whether the combination of L-T4 with L-T3 yields a benefit for a subset of patients is yet to be proven [ 56 , 57 , 58 , 59 ]. Preliminary data show that non-oncological patients with hypothyroidism who carry at least one Thr92Ala-DIO2 polymorphism allele, resulting in lower serum T3 levels, may derive clinical benefit from a combination therapy [ 59 ].…”

Section: Treatment Of Hypothyroidism In Patients With Solid Non-thyro...mentioning

confidence: 99%

“…Whether the combination of L-T4 with L-T3 yields a benefit for a subset of patients is yet to be proven [ 56 , 57 , 58 , 59 ]. Preliminary data show that non-oncological patients with hypothyroidism who carry at least one Thr92Ala-DIO2 polymorphism allele, resulting in lower serum T3 levels, may derive clinical benefit from a combination therapy [ 59 ].…”

Section: Treatment Of Hypothyroidism In Patients With Solid Non-thyro...mentioning

confidence: 99%

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The Clinical Relevance of Hypothyroidism in Patients with Solid Non-Thyroid Cancer: A Tantalizing Conundrum

Deligiorgi

Trafalis

2022

JCM

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Hypothyroidism in patients with solid non-thyroid cancer is a tantalizing entity, integrating an intriguing thyroid hormones (THs)–cancer association with the complexity of hypothyroidism itself. The present narrative review provides a comprehensive overview of the clinical relevance of hypothyroidism in solid non-thyroid cancer. Hypothyroidism in patients with solid non-thyroid cancer is reminiscent of hypothyroidism in the general population, yet also poses distinct challenges due to the dual role of THs in cancer: promoting versus inhibitory. Close collaboration between oncologists and endocrinologists will enable the prompt and personalized diagnosis and treatment of hypothyroidism in patients with solid non-thyroid cancer. Clinical data indicate that hypothyroidism is a predictor of a decreased or increased risk of solid non-thyroid cancer and is a prognostic factor of favorable or unfavorable prognosis in solid non-thyroid cancer. However, the impact of hypothyroidism with respect to the risk and/or prognosis of solid non-thyroid cancer is not a consistent finding. To harness hypothyroidism, or THs replacement, as a personalized anticancer strategy for solid non-thyroid cancer, four prerequisites need to be fulfilled, namely: (i) deciphering the dual THs actions in cancer; (ii) identifying interventions in THs status and developing agents that block tumor-promoting THs actions and/or mimic anticancer THs actions; (iii) appropriate patient selection; and (iv) counteracting current methodological limitations.

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Section: Treatment Of Hypothyroidism In Patients With Solid Non-thyro...mentioning

confidence: 99%

Section: Treatment Of Hypothyroidism In Patients With Solid Non-thyro...mentioning

confidence: 99%

The Clinical Relevance of Hypothyroidism in Patients with Solid Non-Thyroid Cancer: A Tantalizing Conundrum

Deligiorgi

Trafalis

2022

JCM

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“…Hypothyroidism, the inevitable outcome of total thyroidectomy and ablative RAI therapy, necessitates thyroid hormone replacement that is associated with some difficulties to mimic the physiological status of thyroid function (52,53). The findings of a Swedish randomized trial of 179 patients with Graves' hyperthyroidism and followup duration of 4 -10 years to compare the three therapeutic options showed that ATD use for 18 months was associated with the highest relapse rate.…”

Section: Comparison Of Different Therapeutic Modalities For Graves' Hyperthyroidismmentioning

confidence: 99%

Management of Graves’ Hyperthyroidism: More Than a Century of Progression

Abdi

Amouzegar

2020

Int J Endocrinol Metab

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Context: There are three therapeutic modalities for the management of Graves’ disease (GD), including thyroid surgery, radioactive iodine (RAI), and antithyroid drugs (ATDs). We aimed to briefly review the history of these treatment strategies and their advantages and disadvantages. Evidence Acquisition: We searched PubMed for English language articles using pertinent search terms. Results: Each treatment modality for GD is accompanied by several advantages and disadvantages. Nowadays, ATDs are the most commonly prescribed therapy for GD worldwide. The lack of well-designed, large RCTs comparing three different treatments for hyperthyroidism concerning various short-term and long-term outcomes has led to remarkable uncertainty in the preference of each of these treatments, as is evident in relevant guidelines from different societies. Recently, the efficacy and safety of long-term use of ATDs have been documented. Conclusions: Pros and cons of each therapeutic modality for Graves’ hyperthyroidism should be taken into account during the physician-patient discussion to select the primary treatment. Considering recent data about the long-term efficacy and safety of ATDs, it seems that the appropriate selection of Graves’ patients for long-term ATD therapy can be a new avenue in the treatment and even cure of GD.

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“…The non-conclusive results, besides heterogeneity in the study population, design, and dosage, may be attributed to the concerns and challenges regarding available oral T3 preparations stemming from the short half-life of T3 with rapid T3 absorption followed by fast metabolization [ 14 – 17 ]. Despite the lack of definite evidence for the superiority of combination therapy, this strategy remains a common practice in hypothyroid patients who remained dissatisfied with LT4 monotherapy, while the use of LT4 + SR-T3 was suggested [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Pharmacodynamic and pharmacokinetic properties of the combined preparation of levothyroxine plus sustained- release liothyronine; a randomized controlled clinical trial

Mehran,

Amouzegar,

Foroutan

et al. 2023

BMC Endocr Disord

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Background Understanding pharmacokinetics (PK) and pharmacodynamics (PD) of the sustained-release liothyronine (SR-T3) is of paramount importance to design therapeutic regimens that are able to simulate normal thyroid hormone secretion while avoiding excursions in the T3 serum concentration. Here, we designed a parallel randomized clinical trial to characterize the PK and PD of the combined preparations of LT4 + SR-T3 in hypothyroid patients. Methods Radioiodine-treated hypothyroid patients over 20 years of age, who attained euthyroidism with LT4 monotherapy were recruited from the Endocrine Clinic in Tehran. The patients were allocated to two intervention groups of group A: 9 µg SR-T3 plus 68.5 μg LT4 (ratio 1:7.5) and group B: 12 µg SR-T3 plus 60 µg LT4 (ratio 1:5), and a control group with LT4 monotherapy. For PD study, thyroid hormone profile was evaluated at 8 and 12 weeks intervals after intervention. To assess PK properties of SR-T3, T3-Cmax, T3-Tmax and AUC0 − 24 were calculated at the last visit. Results Serum T4 and FT4 concentrations decreased in the intervention groups after 3 months. No significant difference was observed in serum T3 and FT3 concentrations before and after intervention. Serum T3/T4 ratio increased significantly in the intervention groups after intervention, with the highest increase in group B from 8.6 ± 2.03 at baseline to 12.2 ± 1.6. Comparison of trial groups at follow-up showed no differences in serum TSH, T4, T3 and T3/T4 concentrations among different groups. During 24 h, minimal variation in serum T3 concentration was observed in group B with mean ∆T3 of 15.4 ± 10.5 ng/dl. T3-Tmax, T3-Cmax and AUC0 − 24 in the combined sustained-release preparation were 4.38 ± 1.1 h., 101.0 ± 5.7 ng/dl and 2257 ± 110 ng.h/L, respectively which were significantly different from the control group. Conclusion Combined treatment with a single dose of SR-T3 plus LT4 is associated with increased serum T3/T4 ratio and minimal excursions in serum T3 concentration during 24 h; however, it was not significantly different from the control group. To incorporate sustained-release T3 in the management of hypothyroidism, a higher ratio of SR-T3 to LT4 than that of the previously recommended by the international organizations is suggested. IRCT registration number IRCT20100922004794N13. https://www.irct.ir/search/result?query=IRCT20100922004794N13. Registration date: 08/12/2021.

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LT4 and Slow Release T3 Combination: Optimum Therapy for Hypothyroidism?

Cited by 4 publications

References 42 publications

The Clinical Relevance of Hypothyroidism in Patients with Solid Non-Thyroid Cancer: A Tantalizing Conundrum

The Clinical Relevance of Hypothyroidism in Patients with Solid Non-Thyroid Cancer: A Tantalizing Conundrum

Management of Graves’ Hyperthyroidism: More Than a Century of Progression

Pharmacodynamic and pharmacokinetic properties of the combined preparation of levothyroxine plus sustained- release liothyronine; a randomized controlled clinical trial

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