Combined therapy with levothyroxine and liothyronine for hypothyroidism

Fischman, Alexandra; Domínguez, José Miguel

doi:10.5867/medwave.2018.08.7375

Cited by 5 publications

(4 citation statements)

References 15 publications

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“…An initial double-blind, randomized trial in patients with hypothyroidism demonstrated improvements in mood and neuropsychological function in patients for whom T3 was given in place of a proportion of their LT4 dose ( 32 ). Further evidence from randomized or observational studies has supported the possibility of significant differences in quality of life (QoL) scores or psychological scores in favor of the combination vs LT4 monotherapy ( 33 , 34 ), but a benefit for the combination for improved quality of life or other outcomes is not supported by systematic reviews or meta-analyses conducted as recently as 2018 ( 35 , 36 , 37 , 38 , 39 ). Importantly, about half of the patients enrolled in double-blind trials preferred the combination to LT4 monotherapy, however ( 40 ).…”

Section: Possible Explanations For Continuing Symptoms Despite ‘Adequmentioning

confidence: 99%

Managing symptoms in hypothyroid patients on adequate levothyroxine: a narrative review

Razvi

Mrabeti²,

Luster

2020

Endocrine Connections

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The current standard of care for hypothyroidism is levothyroxine (LT4) monotherapy to reduce levels of thyrotropin (thyroid stimulating hormone, TSH) to within its reference range and amelioration of any symptoms. A substantial minority continue to report hypothyroid-like symptoms despite optimised TSH, however. These symptoms are not specific to thyroid dysfunction and are frequent among the euthyroid population, creating a therapeutic dilemma for the treating clinician as well as the patient. We present a concise, narrative review of the clinical research and evidence-based guidance on the management of this challenging population. The clinician may endeavour to ensure that the serum TSH is within the target range. However, the symptomatic patient may turn to alternative non-evidence-based therapies in the hope of obtaining relief. Accordingly, it is important for the clinician to check for conditions unrelated to the thyroid that could account for the ongoing symptoms such as other autoimmune conditions, anaemia or mental health disorders. Systematic and thorough investigation of the potential causes of persistent symptoms while receiving LT4 therapy will resolve the problem for most patients. There may be some patients that may benefit from additional treatment with liothyronine (LT3), although it is unclear as yet as to which patient group may benefit the most from combined LT4 + LT3 therapy. In the future, personalised treatment with LT4 + LT3 may be of benefit for some patients with persistent symptoms of hypothyroidism such as those with polymorphisms in the deiodinase enzyme 2 (DIO2). For now, this remains a subject for research.

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Section: Possible Explanations For Continuing Symptoms Despite ‘Adequmentioning

confidence: 99%

Managing symptoms in hypothyroid patients on adequate levothyroxine: a narrative review

Razvi

Mrabeti²,

Luster

2020

Endocrine Connections

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“…The other study included more patients (n = 59), but used a large and potentially unphysiological dose of T3 (20 mcg daily). 34 Two recent systematic reviews 35,36 and a meta-analysis 37 evaluating fourteen randomized controlled trials concluded that L-T4+L-T3 and desiccated thyroid extract (DTE), which has a significantly higher T3:T4 ratio than that produced by humans, were no different to L-T4 alone in terms of QoL, neurocognitive function and somatic symptoms.…”

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confidence: 99%

The enigma of persistent symptoms in hypothyroid patients treated with levothyroxine: A narrative review

Perros

Feltz‐Cornelis

Papini

et al. 2021

Clinical Endocrinology

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Overt hypothyroidism [raised serum thyroid-stimulating hormone (TSH) associated with low serum-free thyroxine (FT4)] and subclinical hypothyroidism (raised TSH with normal serum FT4) affect 2%-10% of the population. 1 Autoimmunity is the cause of hypothyroidism in about 80% of cases. 1 While in most patients treatment with levothyroxine (L-T4) restores health, 10%-15% of patients do not regain their well-being after apparently adequate treatment with L-T4. [2][3][4] Persistent symptoms are non-specific and include fatigue, weight gain and mood changes. 1,5 Such symptoms may lead to multiple medical consultations, patient requests for inappropriate investigations and dissatisfaction with treatment. [5][6][7] Given the high prevalence of hypothyroidism, this loss of wellbeing in a significant fraction of patients causes considerable socio-economic burden 8 and clinical management can be difficult and frustrating both for patients and for clinicians. 7 The underlying causes for persistent symptoms are unclear. Here, we outline |

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“…There is no consensus about the best treatment approach for those patients who do not respond to standard treatment with levothyroxine alone. According to the recommendations, patients with hypothyroidism should be treated with levothyroxine monotherapy [ 8 , 9 ]; however, the addition of liothyronine has been proposed as a beneficial and safe therapy in the management of hypothyroidism symptoms, mainly in quality of life [ 20 , 21 , 27 ], weight management, fatigue, mood, and memory [ 28 ]. The development of clinical trials evaluating the effect of this intervention on persistent fatigue in different populations would be encouraging in the management of patients with hypothyroidism.…”

Section: Discussionmentioning

confidence: 99%

Severity of Fatigue and Its Relationship with TSH before and after Levothyroxine Replacement Therapy in Patients with Primary Hypothyroidism

et al. 2023

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Background: Fatigue is a common symptom in hypothyroidism; however, the effect of levothyroxine on fatigue has been little studied. The aim of this study was to evaluate the effect of levothyroxine on fatigue in Latino patients with primary hypothyroidism, as well as the association of TSH and free T4 (FT4) with the severity and persistence of fatigue. Methods: A prospective study was performed in 92 patients with primary hypothyroidism. Fatigue severity scale (FSS) scores and clinical and biochemical characteristics before and at 6 months of levothyroxine were evaluated. Results: After 6 months of levothyroxine, a reduction in FSS (53 (47–57) vs. 36 (16–38); p = 0.001) and fatigue frequency (45.7% vs. 26.1%; p = 0.008) was evident. Both before and after 6 months of levothyroxine, there was a positive correlation of the FSS score with TSH and a negative correlation with FT4. Persistent fatigue was associated with a pretreatment FSS score (r = 0.75; p = 0.001) and diabetes (r = 0.40; p = 0.001). An FSS > 34 (RR 3.9 (95% CI 1.43–10.73; p = 0.008)), an FSS > 36 (RR 3.23 (95% CI 1.21–8.6; p = 0.019)), and diabetes (RR 5.7 (95% CI 1.25–9.6; p = 0.024)) before treatment were risk factors for persistent fatigue. Conclusions: Levothyroxine improved fatigue in most patients. Diabetes and an FSS score >34 or >36 before treatment were risk factors for persistent fatigue.

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Combined therapy with levothyroxine and liothyronine for hypothyroidism

Cited by 5 publications

References 15 publications

Managing symptoms in hypothyroid patients on adequate levothyroxine: a narrative review

Managing symptoms in hypothyroid patients on adequate levothyroxine: a narrative review

The enigma of persistent symptoms in hypothyroid patients treated with levothyroxine: A narrative review

Severity of Fatigue and Its Relationship with TSH before and after Levothyroxine Replacement Therapy in Patients with Primary Hypothyroidism

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