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Combination Thyroid Hormone Replacement; Knowns and Unknowns
Hypothyroidism is common throughout the world and readily diagnosed with thyroid function tests. Management should be straightforward but appears not to be the case. Thyroid hormone replacement with levothyroxine monotherapy is the standard treatment which is effective in the majority of cases. Howe...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6817486/ https://www.ncbi.nlm.nih.gov/pubmed/31695677 http://dx.doi.org/10.3389/fendo.2019.00706 |
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author | Taylor, Peter N. Eligar, Vinay Muller, Ilaria Scholz, Anna Dayan, Colin Okosieme, Onyebuchi |
author_facet | Taylor, Peter N. Eligar, Vinay Muller, Ilaria Scholz, Anna Dayan, Colin Okosieme, Onyebuchi |
author_sort | Taylor, Peter N. |
collection | PubMed |
description | Hypothyroidism is common throughout the world and readily diagnosed with thyroid function tests. Management should be straightforward but appears not to be the case. Thyroid hormone replacement with levothyroxine monotherapy is the standard treatment which is effective in the majority of cases. However, 10–15% of patients established on levothyroxine do not feel their health is entirely restored and some patients prefer the addition of liothyronine. Proponents of liothyronine argue that the ratio of T3 and T4 hormones is substantially altered on T4 monotherapy and therefore both hormones may be needed for optimal health. This remains controversial as clinical trials have not demonstrated superiority of combination therapy (levothyroxine and liothyronine) over levothyroxine monotherapy. There is now a pressing need for further studies and in particular randomized controlled trials in this area. To help design and facilitate dedicated trials and better understand thyroid hormone replacement, this review summarizes the evidence where there is established knowledge and agreement (knowns) and areas where research is lacking (unknowns). Agreements include the extent of dissatisfaction with levothyroxine monotherapy, biases in testing for hypothyroidism and prescribing levothyroxine, as well as variable thresholds for prescribing levothyroxine and challenges in liothyronine dosing. The review will also highlight and summarize the unknowns including the long-term safety profile of liothyronine, and potential biomarkers to identify individuals who might benefit most from combination therapy. |
format | Online Article Text |
id | pubmed-6817486 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-68174862019-11-06 Combination Thyroid Hormone Replacement; Knowns and Unknowns Taylor, Peter N. Eligar, Vinay Muller, Ilaria Scholz, Anna Dayan, Colin Okosieme, Onyebuchi Front Endocrinol (Lausanne) Endocrinology Hypothyroidism is common throughout the world and readily diagnosed with thyroid function tests. Management should be straightforward but appears not to be the case. Thyroid hormone replacement with levothyroxine monotherapy is the standard treatment which is effective in the majority of cases. However, 10–15% of patients established on levothyroxine do not feel their health is entirely restored and some patients prefer the addition of liothyronine. Proponents of liothyronine argue that the ratio of T3 and T4 hormones is substantially altered on T4 monotherapy and therefore both hormones may be needed for optimal health. This remains controversial as clinical trials have not demonstrated superiority of combination therapy (levothyroxine and liothyronine) over levothyroxine monotherapy. There is now a pressing need for further studies and in particular randomized controlled trials in this area. To help design and facilitate dedicated trials and better understand thyroid hormone replacement, this review summarizes the evidence where there is established knowledge and agreement (knowns) and areas where research is lacking (unknowns). Agreements include the extent of dissatisfaction with levothyroxine monotherapy, biases in testing for hypothyroidism and prescribing levothyroxine, as well as variable thresholds for prescribing levothyroxine and challenges in liothyronine dosing. The review will also highlight and summarize the unknowns including the long-term safety profile of liothyronine, and potential biomarkers to identify individuals who might benefit most from combination therapy. Frontiers Media S.A. 2019-10-22 /pmc/articles/PMC6817486/ /pubmed/31695677 http://dx.doi.org/10.3389/fendo.2019.00706 Text en Copyright © 2019 Taylor, Eligar, Muller, Scholz, Dayan and Okosieme. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Endocrinology Taylor, Peter N. Eligar, Vinay Muller, Ilaria Scholz, Anna Dayan, Colin Okosieme, Onyebuchi Combination Thyroid Hormone Replacement; Knowns and Unknowns |
title | Combination Thyroid Hormone Replacement; Knowns and Unknowns |
title_full | Combination Thyroid Hormone Replacement; Knowns and Unknowns |
title_fullStr | Combination Thyroid Hormone Replacement; Knowns and Unknowns |
title_full_unstemmed | Combination Thyroid Hormone Replacement; Knowns and Unknowns |
title_short | Combination Thyroid Hormone Replacement; Knowns and Unknowns |
title_sort | combination thyroid hormone replacement; knowns and unknowns |
topic | Endocrinology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6817486/ https://www.ncbi.nlm.nih.gov/pubmed/31695677 http://dx.doi.org/10.3389/fendo.2019.00706 |
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