Combination Treatment with T4 and T3: Toward Personalized Replacement Therapy in Hypothyroidism?
Bernadette Biondi and Leonard Wartofsky
Evidence AcquisitionWe searched Medline for reports published with the following search terms: hypothyroidism, levothyroxine, triiodothyronine, thyroid, guidelines, treatment, deiodinases, clinical symptoms, quality of life, cognition, mood, depression, body weight, heart rate, cholesterol, bone markers, SHBG, and patient preference for combined therapy.
The search was restricted to reports published in English since 1970, but some reports published before 1970 were also incorporated. We supplemented the search with records from personal files and references of relevant articles and textbooks.
Parameters analyzed included the rationale for combination treatment, the type of patients to be selected, the optimal T4/T3 ratio, and the potential benefits of this therapy on symptoms of hypothyroidism, quality of life, mood, cognition, and peripheral parameters of thyroid hormone action.
Evidence SynthesisThe outcome of our analysis suggests that it may be time to consider a personalized regimen of thyroid hormone replacement therapy in hypothyroid patients.
ConclusionsFurther prospective randomized controlled studies are needed to clarify this important issue. Innovative formulations of the thyroid hormones will be required to mimic a more perfect thyroid hormone replacement therapy than is currently available.
Verder lezen op Schildkliertje
- Wel of geen T3 bij hypothyreoïdie?
- Onderzoek naar T3 met vertraagde afgifte
- Uitdagingen voor de moderne endocrinologie
- 2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism