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Liothyronine Improves Biochemical Control of Congenital Hypothyroidism in Patients with Central Resistance to Thyroid Hormone.
J Pediatr 2016; 175:167-172.e1JPed

Abstract

OBJECTIVE

To assess whether adding liothyronine (LT3) to levothyroxine (LT4) monotherapy normalizes serum thyrotropin (TSH) and thyroxine (T4) concentrations in children with congenital hypothyroidism and central resistance to thyroid hormone.

STUDY DESIGN

We retrospectively studied 12 patients with congenital hypothyroidism and central resistance to thyroid hormone (6 treated with LT3+LT4 combined therapy and 6 treated with LT4 monotherapy). In patients receiving combined therapy, we compared serum concentrations of TSH, T4, and triiodothyronine before and after addition of LT3. We used repeated measures analysis to compare thyroid function in participants receiving combined therapy vs monotherapy, while accounting for age and intrasubject correlation.

RESULTS

In patients receiving combined therapy, the addition of LT3 was associated with normalization of mean TSH (9.2 vs 4.5 mIU/L, P = .002), a lower proportion of TSH values greater than 10 mIU/L (35% vs 8%, P = .03), and a decrease in mean serum T4 by 23 ± 9% (P < .001). Compared with patients receiving LT4 monotherapy, patients receiving combined therapy had lower mean TSH (8.5 ± 0.9 vs 4.3 ± 0.4, P < .001), lower odds of TSH elevation greater than 10 mIU/L (OR 0.20, 95% CI 0.10-0.41, P < .001), and lower odds of T4 elevation (OR 0.21, 95% CI 0.04-1.09, P = .06). LT3 treatment did not increase serum T3 levels significantly.

CONCLUSION

The addition of LT3 to LT4 monotherapy facilitates normalization of both serum TSH and T4 in patients with congenital hypothyroidism and central resistance to thyroid hormone. Larger prospective studies are needed to confirm these findings and to determine the effect of combined therapy on neurodevelopmental outcomes.

Authors+Show Affiliations

Endocrinology and Diabetic Unit, Bambino Gesù Children's Hospital, Rome, Italy.Division of Endocrinology, Boston Children's Hospital, Boston, MA.Clinical Research Center, Boston Children's Hospital, Boston, MA.Division of Endocrinology, Boston Children's Hospital, Boston, MA.Division of Endocrinology, Boston Children's Hospital, Boston, MA. Electronic address: ari.wassner@childrens.harvard.edu.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

27178621

Citation

Paone, Laura, et al. "Liothyronine Improves Biochemical Control of Congenital Hypothyroidism in Patients With Central Resistance to Thyroid Hormone." The Journal of Pediatrics, vol. 175, 2016, pp. 167-172.e1.
Paone L, Fleisch AF, Feldman HA, et al. Liothyronine Improves Biochemical Control of Congenital Hypothyroidism in Patients with Central Resistance to Thyroid Hormone. J Pediatr. 2016;175:167-172.e1.
Paone, L., Fleisch, A. F., Feldman, H. A., Brown, R. S., & Wassner, A. J. (2016). Liothyronine Improves Biochemical Control of Congenital Hypothyroidism in Patients with Central Resistance to Thyroid Hormone. The Journal of Pediatrics, 175, pp. 167-172.e1. doi:10.1016/j.jpeds.2016.04.022.
Paone L, et al. Liothyronine Improves Biochemical Control of Congenital Hypothyroidism in Patients With Central Resistance to Thyroid Hormone. J Pediatr. 2016;175:167-172.e1. PubMed PMID: 27178621.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Liothyronine Improves Biochemical Control of Congenital Hypothyroidism in Patients with Central Resistance to Thyroid Hormone. AU - Paone,Laura, AU - Fleisch,Abby F, AU - Feldman,Henry A, AU - Brown,Rosalind S, AU - Wassner,Ari J, Y1 - 2016/05/11/ PY - 2015/12/21/received PY - 2016/03/24/revised PY - 2016/04/07/accepted PY - 2016/5/15/entrez PY - 2016/5/15/pubmed PY - 2017/6/10/medline KW - combined therapy KW - thyroid hormone resistance SP - 167 EP - 172.e1 JF - The Journal of pediatrics JO - J. Pediatr. VL - 175 N2 - OBJECTIVE: To assess whether adding liothyronine (LT3) to levothyroxine (LT4) monotherapy normalizes serum thyrotropin (TSH) and thyroxine (T4) concentrations in children with congenital hypothyroidism and central resistance to thyroid hormone. STUDY DESIGN: We retrospectively studied 12 patients with congenital hypothyroidism and central resistance to thyroid hormone (6 treated with LT3+LT4 combined therapy and 6 treated with LT4 monotherapy). In patients receiving combined therapy, we compared serum concentrations of TSH, T4, and triiodothyronine before and after addition of LT3. We used repeated measures analysis to compare thyroid function in participants receiving combined therapy vs monotherapy, while accounting for age and intrasubject correlation. RESULTS: In patients receiving combined therapy, the addition of LT3 was associated with normalization of mean TSH (9.2 vs 4.5 mIU/L, P = .002), a lower proportion of TSH values greater than 10 mIU/L (35% vs 8%, P = .03), and a decrease in mean serum T4 by 23 ± 9% (P < .001). Compared with patients receiving LT4 monotherapy, patients receiving combined therapy had lower mean TSH (8.5 ± 0.9 vs 4.3 ± 0.4, P < .001), lower odds of TSH elevation greater than 10 mIU/L (OR 0.20, 95% CI 0.10-0.41, P < .001), and lower odds of T4 elevation (OR 0.21, 95% CI 0.04-1.09, P = .06). LT3 treatment did not increase serum T3 levels significantly. CONCLUSION: The addition of LT3 to LT4 monotherapy facilitates normalization of both serum TSH and T4 in patients with congenital hypothyroidism and central resistance to thyroid hormone. Larger prospective studies are needed to confirm these findings and to determine the effect of combined therapy on neurodevelopmental outcomes. SN - 1097-6833 UR - https://www.unboundmedicine.com/medline/citation/27178621/Liothyronine_Improves_Biochemical_Control_of_Congenital_Hypothyroidism_in_Patients_with_Central_Resistance_to_Thyroid_Hormone_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3476(16)30070-1 DB - PRIME DP - Unbound Medicine ER -