There is no ‘universal fit’: Reflections on the use of l-triiodothyronine in the treatment of hypothyroidism

Duntas, Leonidas H.; Wartofsky, Léonard

doi:10.1016/j.metabol.2015.11.005

Cited by 3 publications

(3 citation statements)

References 30 publications

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“…Also, for an optimal RCT, a need for personalized treatment to avoid overtreatment, especially in older patients [19], and consideration regarding dietary and nutritional factors influencing the thyroid function (such as iodine, selenium, and vitamin D) should be (if possible) considered. Furthermore, a slow-release low-dose T 3 , optimal in combination with T 4 , would be the optimal drug to use instead of the complicated dose regimen used in this study.…”

Section: Discussionmentioning

confidence: 99%

Levothyroxine/Liothyronine Combination Therapy and Quality of Life: Is It All about Weight Loss?

Michaelsson¹,

Cour²,

Medici³

et al. 2018

Eur Thyroid J

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Objectives: According to one hypothesis, the popularity of levothyroxine (L-T₄)/liothyronine (L-T₃) combination therapy relates to weight loss. The purpose of this study was to detect a possible correlation between thyroid-related quality of life (QoL) and weight loss in hypothyroid patients switched from L-T₄ monotherapy to L-T₄/L-T₃ combination therapy. Methods: In an open-label cohort study, all hypothyroid patients referred to the University Hospital endocrine clinic due to persistent symptoms despite adequate L-T₄ monotherapy (without other explanations for the symptoms) were switched from L-T₄ monotherapy to L-T₄/ L-T₃ combination therapy at a ratio of approximately 17/1. At baseline and after 3 months of treatment we measured: QoL by the Thyroid Patient-Reported Outcome (ThyPRO-39) questionnaire, thyroid hormones, body weight, body composition by a DEXA-scan, and cognitive function by evaluating participants’ reaction time as well as working memory by the California Computerized Assessment Package (CalCAP®). QoL was re-evaluated after 12 months. Results: Twenty-three patients participated (91% women, median age 47 years). The ThyPRO-39 composite score decreased from a median of 54 (quartiles: 34, 74) to 15 (11, 28) after 3 months (p < 0.0001), and 20 (14, 26) after 12 months, indicating a better QoL. There was no change in body weight, and no correlations between QoL and weight. There was a slight improvement in cognitive function, whereas body composition, heart rate, and serum TSH did not change. Conclusion: Our study on hypothyroid patients switched from L-T₄ monotherapy to L-T₄/L-T₃ combination therapy showed a substantial improvement in QoL measured by the ThyPRO-39. This improvement could not be explained by weight loss.

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Section: Discussionmentioning

confidence: 99%

Levothyroxine/Liothyronine Combination Therapy and Quality of Life: Is It All about Weight Loss?

Michaelsson¹,

Cour²,

Medici³

et al. 2018

Eur Thyroid J

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“…there remains a persistent concept that addition of LT3 has a role in the treatment of hypothyroidism, that is, to improve persistent symptoms. 15 Others point to findings that approximately one-fifth of thyroidectomised patients treated with LT4 in a large retrospective study did not have free T3 or free T4 in the reference range although TSH levels were normal. 16 They argue that conversion of LT4 to T3 is not adequate in some patients, who may benefit from addition of LT3 to ameliorate lingering symptoms.…”

Section: Message For the Clinicmentioning

confidence: 99%

“…Research in rats has indicated that, in certain tissue types, increased T4 levels inhibit endogenous conversion of T4 to T3; however, it is acknowledged that this effect is likely to be relatively modest in humans because of interspecies differences in peripheral conversion . Despite this, there remains a persistent concept that addition of LT3 has a role in the treatment of hypothyroidism, that is, to improve persistent symptoms . Others point to findings that approximately one‐fifth of thyroidectomised patients treated with LT4 in a large retrospective study did not have free T3 or free T4 in the reference range although TSH levels were normal .…”

Section: Introductionmentioning

confidence: 99%

Current evidence for the treatment of hypothyroidism with levothyroxine/levotriiodothyronine combination therapy versus levothyroxine monotherapy

Hennessey

Espaillat

2018

Int J Clin Pract

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SummaryObjectiveHypothyroidism is relatively common, occurring in approximately 5% of the general US population aged ≥12 years. Levothyroxine (LT4) monotherapy is the standard of care. Approximately, 5%‐10% of patients who normalise thyroid‐stimulating hormone levels with LT4 monotherapy may have persistent symptoms that patients and clinicians may attribute to hypothyroidism. A long‐standing debate in the literature is whether addition of levotriiodothyronine (LT3) to LT4 will ameliorate lingering symptoms. Here, we explore the evidence for and against LT4/LT3 combination therapy as the optimal approach to treat euthyroid patients with persistent complaints.MethodsRecent literature indexed on PubMed was searched in March 2017 using the terms “hypothyroid” or “hypothyroidism” and “triiodothyronine combination” or “T3 combination.” Relevant non‐review articles published in English during the past 10 years were included and supplemented with articles already known to the authors.FindingsCurrent clinical evidence is not sufficiently strong to support LT4/LT3 combination therapy in patients with hypothyroidism. Polymorphisms in deiodinase genes that encode the enzymes that convert T4 to T3 in the periphery may provide potential mechanisms underlying unsatisfactory treatment results with LT4 monotherapy. However, results of studies on the effect of LT4/LT3 therapy on clinical symptoms and thyroid‐responsive genes have thus far not been conclusive.ConclusionsPersistent symptoms in patients who are biochemically euthyroid with LT4 monotherapy may be caused by several other conditions unrelated to thyroid function, and their cause should be aggressively investigated by the clinician.

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Comparison of Thyroid Hormones in Euthyroid Athyreotic Patients Treated with Levothyroxine and Euthyroid Healthy Subjects

Jeon

Lee

et al. 2019

Int J Thyroidol

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There is no ‘universal fit’: Reflections on the use of l-triiodothyronine in the treatment of hypothyroidism

Cited by 3 publications

References 30 publications

Levothyroxine/Liothyronine Combination Therapy and Quality of Life: Is It All about Weight Loss?

Levothyroxine/Liothyronine Combination Therapy and Quality of Life: Is It All about Weight Loss?

Current evidence for the treatment of hypothyroidism with levothyroxine/levotriiodothyronine combination therapy versus levothyroxine monotherapy

Comparison of Thyroid Hormones in Euthyroid Athyreotic Patients Treated with Levothyroxine and Euthyroid Healthy Subjects

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