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2018 ; 72
(2
): ä Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Current evidence for the treatment of hypothyroidism with
levothyroxine/levotriiodothyronine combination therapy versus levothyroxine
monotherapy
#MMPMID29381251
Hennessey JV
; Espaillat R
Int J Clin Pract
2018[Feb]; 72
(2
): ä PMID29381251
show ga
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.