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Current evidence for the treatment of hypothyroidism with levothyroxine/levotriiodothyronine combination therapy versus levothyroxine monotherapy.
Int J Clin Pract 2018; 72(2)IJ

Abstract

OBJECTIVE

Hypothyroidism 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.

METHODS

Recent 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.

FINDINGS

Current 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.

CONCLUSIONS

Persistent 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.

Authors+Show Affiliations

Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.AbbVie Inc., North Chicago, IL, USA.

Pub Type(s)

Comparative Study
Journal Article
Review

Language

eng

PubMed ID

29381251

Citation

Hennessey, James V., and Ramon Espaillat. "Current Evidence for the Treatment of Hypothyroidism With Levothyroxine/levotriiodothyronine Combination Therapy Versus Levothyroxine Monotherapy." International Journal of Clinical Practice, vol. 72, no. 2, 2018.
Hennessey JV, Espaillat R. Current evidence for the treatment of hypothyroidism with levothyroxine/levotriiodothyronine combination therapy versus levothyroxine monotherapy. Int J Clin Pract. 2018;72(2).
Hennessey, J. V., & Espaillat, R. (2018). Current evidence for the treatment of hypothyroidism with levothyroxine/levotriiodothyronine combination therapy versus levothyroxine monotherapy. International Journal of Clinical Practice, 72(2), doi:10.1111/ijcp.13062.
Hennessey JV, Espaillat R. Current Evidence for the Treatment of Hypothyroidism With Levothyroxine/levotriiodothyronine Combination Therapy Versus Levothyroxine Monotherapy. Int J Clin Pract. 2018;72(2) PubMed PMID: 29381251.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Current evidence for the treatment of hypothyroidism with levothyroxine/levotriiodothyronine combination therapy versus levothyroxine monotherapy. AU - Hennessey,James V, AU - Espaillat,Ramon, Y1 - 2018/01/30/ PY - 2017/09/28/received PY - 2017/12/22/accepted PY - 2018/1/31/pubmed PY - 2018/7/28/medline PY - 2018/1/31/entrez JF - International journal of clinical practice JO - Int. J. Clin. Pract. VL - 72 IS - 2 N2 - OBJECTIVE: Hypothyroidism 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. METHODS: Recent 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. FINDINGS: Current 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. CONCLUSIONS: Persistent 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. SN - 1742-1241 UR - https://www.unboundmedicine.com/medline/citation/29381251/Current_evidence_for_the_treatment_of_hypothyroidism_with_levothyroxine/levotriiodothyronine_combination_therapy_versus_levothyroxine_monotherapy_ L2 - https://doi.org/10.1111/ijcp.13062 DB - PRIME DP - Unbound Medicine ER -