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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...

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Autores principales: Hennessey, James V., Espaillat, Ramon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2018
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.
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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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