Papers Advocating T3/T4 Treatment

[j.]

I think it would be good to have a collection of authors advocating T3 and T4 treatment, or comparing it to T4 monotherapy.

 

[j.]

Peripheral markers of thyroid function: the effect of T4 monotherapy vs T4/T3 combination therapy in hypothyroid subjects in a randomized crossover study

This one discusses the effects on bones.

 

[Blossom]

I think it would be good to have a collection of authors advocating T3 and T4 treatment, or comparing it to T4 monotherapy.

I love it!

 

[aguilaroja]

...a collection of authors advocating T3 and T4 treatment, or comparing it to T4 monotherapy.

I have mentioned the Wirsinga review below in a few posts. It mentions numerous trials. Excuse the repetition.

Mary Shomon is one writer who has been summarizing some of the studies and opinions:

http://thyroid.about.com/od/t3treatment ... atment.htm

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Nat Rev Endocrinol. 2014 Mar;10(3):164-74. doi: 10.1038/nrendo.2013.258. Epub 2014 Jan 14.
Paradigm shifts in thyroid hormone replacement therapies for hypothyroidism. Wiersinga WM.
Abstract
Impaired psychological well-being, depression or anxiety are observed in 5-10% of hypothyroid patients receiving levothyroxine, despite normal TSH levels. Such complaints might hypothetically be related to increased free T4 and decreased free T3 serum concentrations, which result in the abnormally low free T4:free T3 ratios observed in 30% of patients on levothyroxine. Evidence is mounting that levothyroxine monotherapy cannot assure a euthyroid state in all tissues simultaneously, and that normal serum TSH levels in patients receiving levothyroxine reflect pituitary euthyroidism alone. Levothyroxine plus liothyronine combination therapy is gaining in popularity; although the evidence suggests it is generally not superior to levothyroxine monotherapy, in some of the 14 published trials this combination was definitely preferred by patients and associated with improved metabolic profiles. Disappointing results with combination therapy could be related to use of inappropriate levothyroxine and liothyronine doses, resulting in abnormal serum free T4:free T3 ratios. Alternatively, its potential benefit might be confined to patients with specific genetic polymorphisms in thyroid hormone transporters and deiodinases that affect the intracellular levels of T3 available for binding to T3 receptors. Levothyroxine monotherapy remains the standard treatment for hypothyroidism. However, in selected patients, new guidelines suggest that experimental combination therapy might be considered.

 

[Giraffe]

Effect of combination therapy with thyroxine (T4) and 3,5,3'-triiodothyronine versus T4 monotherapy in patients with hypothyroidism, a double-blind, randomised cross-over study

Abstract
Background: Treatment of hypothyroidism with 3,5,3' -triiodothyronine (T3) is controversial. A recent meta-analysis concludes that no evidence is present in favour of using T3. However, the analysis included a mixture of different patient groups and dose-regimens.

Objective: To compare the effect of combination therapy with thyroxine (T4) and T3 versus T4 monotherapy in patients with hypothyroidism on stable T4 substitution.

Study design: Double-blind, randomised cross-over. Fifty micrograms of the usual T4 dose was replaced with either 20 mcgT3 or 50 mgT4 for 12 weeks, followed by cross-over for another 12 weeks. The T4 dose was regulated if needed, intending unaltered serum TSH levels.

Evaluation: Tests for quality of life (QOL) and depression (SF-36, Beck Depression Inventory, and SCL-90-R) at baseline and after both treatment periods.

Inclusion criteria: Serum TSH between 0.1 and 5.0 mU/l on unaltered T4 substitution for 6 months.

Results: A total of 59 patients (55 women); median age 46 years. When comparing scores of QOL and depression on T4 monotherapy versus T4/T3 combination therapy, significant differences were seen in 7 out of 11 scores, indicating a positive effect related to the combination therapy. Forty-nine percent preferred the combination and 15% monotherapy (PZ 0.002). Serum TSH remained unaltered between the groups as intended.

Conclusion: In a study design, where morning TSH levels were unaltered between groups combination therapy, (treated with T3 20 mcg once daily) was superior to monotherapy by evaluating several QOL, depression and anxiety rating scales as well as patients own preference.

European Journal of Endocrinology 161 895–902