LT4 monotherapy remains the standard treatment for hypothyroidism, although a subset of patients continues to have hypothyroidism despite normal TSH and serum-free thyroxine levels.
CHICAGO — Levothyroxine monotherapy remains the standard treatment for hypothyroidism, although a subset of patients continue to have hypothyroidism despite normal thyroid-stimulating hormone and serum-free thyroxine levels. LT4 and liothyronine combination therapy to improve hypothyroidism remains a topic of interest.explored LT4/LT3 combination therapy. Speakers addressed the biochemical and clinical differences between monotherapy and combination therapy.
Patients taking LT4 monotherapy report reduced health-related quality of life, mood, and neurocognitive function, said Jonklaas. Possible causes of what she called the clinical shortcomings of monotherapy include that LT4 does not recapitulate normal thyroid physiology, genetic issues could cause impaired conversion of T4 to T3, or even seemingly unrelated causes like awareness of a chronic condition or that autoimmune status separate from thyroid status could harm quality of life.
Before considering a trial of LT3, confirm a diagnosis of primary hypothyroidism, with a TSH level ≥ 10 and/or low FT4 level. Additionally, exclude comorbidities as the cause of persistent symptoms. Plan on a 3- to 6-month trial of combination therapy while maintaining a TSH level within reference range before assessing response.
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