At the Endocrine Society's annual meeting, two experts weighed in on the longstanding debate.
A minority of patients with hypothyroidism who were treated with LT4 experienced persistent symptoms and reduced qualify of life despite normalization ofNumerous randomized controlled trials comparing the use of LT3 in combination with LT4 or desiccated thyroid extract vs LT4 alone in the treatment of hypothyroidism have shown no objective differences in alleviating symptoms. However, the combination is generally safe, and patients often say they prefer it to LT4 monotherapy.
"The way we know how to fix this is to give patients a combination of T4 and T3…If you have a patient taking levothyroxine who has normal levels of TSH, what you do is lower the dose of levothyroxine and add a small dose of LT3. TSH must remain in the normal range," Bianco said. "If they had very little symptoms on levothyroxine, the changes to a combination therapy didn't do anything…If they were more symptomatic on levothyroxine, this is when switching to combination therapy really exhibited decreased residual symptoms. If you look at the whole cohort, you wouldn't see that. But if you focus on those symptomatic only on thyroxine, those are the ones that really benefit from combination therapy," Bianco said.
And as for adding LT3, there have been 17 randomized controlled trials comparing the combination to LT4 monotherapy, of which just two showed a benefit of the combination. There have also been six meta-analyses showing no benefit except for patient preference.
Thyroid Disorder Thyroid Disease Thyroid Dysfunction Thyroid Thyroid Cancer Thyroid Carcinoma Cancer Of The Thyroid Endocrine Society Endocrinology Endocrine System Meta-Analysis Metabolism Metabolic Quality Of Life QOL Health Related Quality Of Life Health-Related Quality Of Life HRQOL UK Site Content United Kingdom Site Content United Kingdom UK Washington
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