Journal of Nutritional & Environmental Medicine, Volume 11, Number 3, 1 September 2001 , pp. 159-166(8)
Thyroid Insufficiency. Is Thyroxine the Only Valuable Drug?
Baisier, W.V.; Hertoghe, J.; Eeckhaut, W.
Purpose: To evaluate the efficacy of a drug containing both liothyronine and thyroxine (T3 + T4) in hypothyroid patients who were treated, but not cured, with thyroxine (T4 alone).
Design: Practice-based retrospective study of patients’ records.
Materials and Methods: The records of 89 hypothyroid patients, treated elsewhere with thyroxine but still with hypothyroidism, seen in a private practice in Antwerp, Belgium, were compared with those of 832 untreated hypothyroid patients, over the same period of time (May 1984-July 1997).
Results: The same criteria were applied to both groups: a score of eight main symptoms of hypothyroidism and the 24 h urine free T3 dosage. The group of 89 patients, treated elsewhere with T4, but still complaining of symptoms of hypothyroidism, did not really differ from the group of untreated hypothyroid patients as far as symptoms and 24 h urine free T3 were concerned. A number of these patients were followed up during treatment with natural desiccated thyroid (NDT): 40 T4 treated patients and 278 untreated patients. Both groups responded equally favourably to NDT.
Conclusions: Combined T3 + T4 treatment seems to be more effective than treatment with T4 alone in hypothyroid patients.
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N Engl J Med. 1999 Feb 11;340(6):424-9.
Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism.
Bunevicius R, Kazanavicius G, Zalinkevicius R, Prange AJ Jr.
BACKGROUND:
Patients with hypothyroidism are usually treated with thyroxine (levothyroxine) only, although both thyroxine and triiodothyronine are secreted by the normal thyroid gland. Whether thyroid secretion of triiodothyronine is physiologically important is unknown.
METHODS:
We compared the effects of thyroxine alone with those of thyroxine plus triiodothyronine (liothyronine) in 33 patients with hypothyroidism. Each patient was studied for two five-week periods. During one period, the patient received his or her usual dose of thyroxine. During the other, the patient received a regimen in which 50 microg of the usual dose of thyroxine was replaced by 12.5 microg of triiodothyronine. The order in which each patient received the two treatments was randomized. Biochemical, physiologic, and psychological tests were performed at the end of each treatment period.
RESULTS:
The patients had lower serum free and total thyroxine concentrations and higher serum total triiodothyronine concentrations after treatment with thyroxine plus triiodothyronine than after thyroxine alone, whereas the serum thyrotropin concentrations were similar after both treatments. Among 17 scores on tests of cognitive performance and assessments of mood, 6 were better or closer to normal after treatment with thyroxine plus triiodothyronine. Similarly, among 15 visual-analogue scales used to indicate mood and physical status, the results for 10 were significantly better after treatment with thyroxine plus triiodothyronine. The pulse rate and serum sex hormone-binding globulin concentrations were slightly higher after treatment with thyroxine plus triiodothyronine, but blood pressure, serum lipid concentrations, and the results of neurophysiologic tests were similar after the two treatments.
CONCLUSIONS:
In patients with hypothyroidism, partial substitution of triiodothyronine for thyroxine may improve mood and neuropsychological function; this finding suggests a specific effect of the triiodothyronine normally secreted by the thyroid gland.
J Clin Endocrinol Metab. 2013 May;98(5):1982-90. doi: 10.1210/jc.2012-4107. Epub 2013 Mar 28.
Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study.
Hoang TD, Olsen CH, Mai VQ, Clyde PW, Shakir MK.
Context: Patients previously treated with desiccated thyroid extract (DTE), when being switched to levothyroxine (l-T4), occasionally did not feel as well despite adequate dosing based on serum TSH levels. Objective: Our objective was to investigate the effectiveness of DTE compared with l-T4 in hypothyroid patients. Design and Setting: We conducted a randomized, double-blind, crossover study at a tertiary care center. Patients: Patients (n = 70, age 18-65 years) diagnosed with primary hypothyroidism on a stable dose of l-T4 for 6 months were included in the study. Intervention: Patients were randomized to either DTE or l-T4 for 16 weeks and then crossed over for the same duration. Outcome Measures: Biochemical and neurocognitive tests at baseline and at the end of each treatment period were evaluated. Results: There were no differences in symptoms and neurocognitive measurements between the 2 therapies. Patients lost 3 lb on DTE treatment (172.9 ± 36.4 lb vs 175.7 ± 37.7 lb, P < .001). At the end of the study, 34 patients (48.6%) preferred DTE, 13 (18.6%) preferred l-T4, and 23 (32.9%) had no preference. In the subgroup analyses, those patients who preferred DTE lost 4 lb during the DTE treatment, and their subjective symptoms were significantly better while taking DTE as measured by the general health questionnaire-12 and thyroid symptom questionnaire (P < .001 for both). Five variables were predictors of preference for DTE. Conclusion: DTE therapy did not result in a significant improvement in quality of life; however, DTE caused modest weight loss and nearly half (48.6%) of the study patients expressed preference for DTE over l-T4. DTE therapy may be relevant for some hypothyroid patients.
