Adding carbimazole to levothyroxine increases triiodothyronine and improves outcome in patients with primary hypothyroidism: a preliminary study from Egypt

BACKGROUND: Many hypothyroid patients are not tolerant and not satisfied with levothyroxine (LT4). Older studies used large doses of both carbimazole and LT4 for Hashimoto’s thyroiditis (HT), because Graves’ disease (GD) and HT were considered as very closely related syndromes produced by thyroid autoimmunity. OBJECTIVE: The aim of the study was to determine the outcome after adding small doses of carbimazole to reduced doses of LT4 for patients with primary hypothyroidism, who are unable to tolerate LT4. METHODS: The study is a non-randomized, single arm, interventional study. It included 19 female patients diagnosed with primary hypothyroidism who could not tolerate LT4. Subjects were recruited from the outpatient clinic of AL-Azhar University Hospital in Damietta, Egypt from January to March 2015. They were divided into two groups; group 1 included 10 patients with HT and 2 patients with non-specified primary hypothyroidism, and group 2 included 7 patients with subtotal thyroidectomy for GD. All patients received carbimazole (10 mg/day) beside LT4 (25 μg thrice/week) for 10 weeks. Statistical analysis of the data was done by SPSS version 20, using paired-sample t-test, ANOVA, Chi square, and Pearson coefficient test. RESULTS: There was significant increase in free triiodothyronine (FT3) in addition to significant improvement in depression and LT4 tolerance in the whole population. There was non-significant improvement in TSH in group 1 (p=0.053). Surprisingly, in group 2, in spite of significant increase in TSH (p=0.007) and non-significant decrease in free thyroxine (FT4), there was non-significant increase in FT3. Whether carbimazole improves the pathology of the hypothyroid gland or the peripheral deiodination of T4 to T3 (where the serum and tissue levels of the latter may be responsible for improvement of symptoms) is in need of investigation. CONCLUSIONS: Adding carbimazole to LT4 improves FT3, LT4 tolerance, and depression in primary hypothyroid female patients. Further studies are required to determine the appropriate doses of this regimen in different cases. CLINICAL TRIAL REGISTRATION: This study was registered at Thai Clinical Trials Registration center (http://www.clinicaltrials.in.th) with registration ID: TCTR20170123003. FUNDING: The study received no fund or grant.