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Current evidence for the treatment of hypothyroidism with levothyroxine/levotriiodothyronine combination therapy versus levothyroxine monotherapy
OBJECTIVE: Hypothyroidism is relatively common, occurring in approximately 5% of the general US population aged ≥12 years. Levothyroxine (LT4) monotherapy is the standard of care. Approximately, 5%‐10% of patients who normalise thyroid‐stimulating hormone levels with LT4 monotherapy may have persist...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5873391/ https://www.ncbi.nlm.nih.gov/pubmed/29381251 http://dx.doi.org/10.1111/ijcp.13062 |
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author | Hennessey, James V. Espaillat, Ramon |
author_facet | Hennessey, James V. Espaillat, Ramon |
author_sort | Hennessey, James V. |
collection | PubMed |
description | OBJECTIVE: Hypothyroidism is relatively common, occurring in approximately 5% of the general US population aged ≥12 years. Levothyroxine (LT4) monotherapy is the standard of care. Approximately, 5%‐10% of patients who normalise thyroid‐stimulating hormone levels with LT4 monotherapy may have persistent symptoms that patients and clinicians may attribute to hypothyroidism. A long‐standing debate in the literature is whether addition of levotriiodothyronine (LT3) to LT4 will ameliorate lingering symptoms. Here, we explore the evidence for and against LT4/LT3 combination therapy as the optimal approach to treat euthyroid patients with persistent complaints. METHODS: Recent literature indexed on PubMed was searched in March 2017 using the terms “hypothyroid” or “hypothyroidism” and “triiodothyronine combination” or “T3 combination.” Relevant non‐review articles published in English during the past 10 years were included and supplemented with articles already known to the authors. FINDINGS: Current clinical evidence is not sufficiently strong to support LT4/LT3 combination therapy in patients with hypothyroidism. Polymorphisms in deiodinase genes that encode the enzymes that convert T4 to T3 in the periphery may provide potential mechanisms underlying unsatisfactory treatment results with LT4 monotherapy. However, results of studies on the effect of LT4/LT3 therapy on clinical symptoms and thyroid‐responsive genes have thus far not been conclusive. CONCLUSIONS: Persistent symptoms in patients who are biochemically euthyroid with LT4 monotherapy may be caused by several other conditions unrelated to thyroid function, and their cause should be aggressively investigated by the clinician. |
format | Online Article Text |
id | pubmed-5873391 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-58733912018-03-31 Current evidence for the treatment of hypothyroidism with levothyroxine/levotriiodothyronine combination therapy versus levothyroxine monotherapy Hennessey, James V. Espaillat, Ramon Int J Clin Pract Endocrinology OBJECTIVE: Hypothyroidism is relatively common, occurring in approximately 5% of the general US population aged ≥12 years. Levothyroxine (LT4) monotherapy is the standard of care. Approximately, 5%‐10% of patients who normalise thyroid‐stimulating hormone levels with LT4 monotherapy may have persistent symptoms that patients and clinicians may attribute to hypothyroidism. A long‐standing debate in the literature is whether addition of levotriiodothyronine (LT3) to LT4 will ameliorate lingering symptoms. Here, we explore the evidence for and against LT4/LT3 combination therapy as the optimal approach to treat euthyroid patients with persistent complaints. METHODS: Recent literature indexed on PubMed was searched in March 2017 using the terms “hypothyroid” or “hypothyroidism” and “triiodothyronine combination” or “T3 combination.” Relevant non‐review articles published in English during the past 10 years were included and supplemented with articles already known to the authors. FINDINGS: Current clinical evidence is not sufficiently strong to support LT4/LT3 combination therapy in patients with hypothyroidism. Polymorphisms in deiodinase genes that encode the enzymes that convert T4 to T3 in the periphery may provide potential mechanisms underlying unsatisfactory treatment results with LT4 monotherapy. However, results of studies on the effect of LT4/LT3 therapy on clinical symptoms and thyroid‐responsive genes have thus far not been conclusive. CONCLUSIONS: Persistent symptoms in patients who are biochemically euthyroid with LT4 monotherapy may be caused by several other conditions unrelated to thyroid function, and their cause should be aggressively investigated by the clinician. John Wiley and Sons Inc. 2018-01-30 2018-02 /pmc/articles/PMC5873391/ /pubmed/29381251 http://dx.doi.org/10.1111/ijcp.13062 Text en © 2018 The Authors. International Journal of Clinical Practice published by John Wiley & Sons Ltd This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial (http://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Endocrinology Hennessey, James V. Espaillat, Ramon Current evidence for the treatment of hypothyroidism with levothyroxine/levotriiodothyronine combination therapy versus levothyroxine monotherapy |
title | Current evidence for the treatment of hypothyroidism with levothyroxine/levotriiodothyronine combination therapy versus levothyroxine monotherapy |
title_full | Current evidence for the treatment of hypothyroidism with levothyroxine/levotriiodothyronine combination therapy versus levothyroxine monotherapy |
title_fullStr | Current evidence for the treatment of hypothyroidism with levothyroxine/levotriiodothyronine combination therapy versus levothyroxine monotherapy |
title_full_unstemmed | Current evidence for the treatment of hypothyroidism with levothyroxine/levotriiodothyronine combination therapy versus levothyroxine monotherapy |
title_short | Current evidence for the treatment of hypothyroidism with levothyroxine/levotriiodothyronine combination therapy versus levothyroxine monotherapy |
title_sort | current evidence for the treatment of hypothyroidism with levothyroxine/levotriiodothyronine combination therapy versus levothyroxine monotherapy |
topic | Endocrinology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5873391/ https://www.ncbi.nlm.nih.gov/pubmed/29381251 http://dx.doi.org/10.1111/ijcp.13062 |
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