Compelling Information needed about T3 therapy please

Hi, I was wondering if anyone could suggest a good source of information regarding the treatment of hypothyroidism with a combination of T4/T3 or T3 alone. A friend needs to gather together some evidence that she could present to her GP to try and persuade him to prescribe or refer her. She was diagnosed at 9 with Hashimotos and has spent the last 30 years on a high level of Levo, and felt exhausted, chilled to the bone, and in agony from head to toe. Because this is how it's always been, she had grown to accept that's what life would be like, and has never questioned it - however, she is becoming more unwell now and it was only over Louise's petition, which I shared on Facebook, that she realised there were other treatment options.

I figured she had more chance of getting a referral and T3 than NDT of course. I just wondered if there were any compelling articles or papers that had been recently published that could help her. I have suggested she sign up here

Sorry for the essay, thanks for reading it - I feel bad that her whole life has been spent ill unnecessarily and want to do whatever I can to help.

[Hennerton]

First of all it would be helpful if she simply makes an appointment with her GP for a blood test and this must be for TSH, which they will do automatically and most importantly also for free T4 and free T3. This will show what is possibly happening to her high dose of Levo. What is it by the way? She should also ask her GP for a batch of other tests, these being iron, ferritin, Vit D, B12 and folate. Any or all of these may be low and cause problems with processing T4 to useable T3. They should all be high in range. My own problems were caused by low iron but although I had frequent tests, nobody had ever picked up on it.

When you have all these, post again for advice and in the meantime I am sure someone will respond with some info on T3. It may not be very helpful, however, as you are probably aware that the whole thyroid business is a disaster for patients and that is why this forum and the petition exist.

[Hidden in reply to Hennerton]

Hi, she is on 200 mcg of Levo, she has never seen her results but has been assured that they are within range so there is nothing more they can do. I've suggested she gets those vitamin and mineral levels checked and asks to see her blood results, thanks.

[Aurealis]

This is available on the web

European Journal of Endocrinology (2009) 161 895–902 ISSN 0804-4643 CLINICAL STUDY

Effect of combination therapy with thyroxine (T4) and 3,5,30-triiodothyronine versus T4 monotherapy in patients with hypothyroidism, a double-blind, randomised cross-over study Birte Nygaard, Ebbe Winther Jensen, Jan Kvetny1, Anne Jarløv2 and Jens Faber

Abstract

Background: Treatment of hypothyroidism with 3,5,30-triiodothyronine (T3) is controversial. A recent meta-analysis concludes that no evidence is present in favour of using T3. However, the analysis included a mixture of different patient groups and dose-regimens.

Objective: To compare the effect of combination therapy with thyroxine (T4) and T3 versus T4 monotherapy in patients with hypothyroidism on stable T4 substitution.

Study design: Double-blind, randomised cross-over. Fifty micrograms of the usual T4 dose was replaced with either 20 mg T3 or 50 mg T4 for 12 weeks, followed by cross-over for another 12 weeks. The T4 dose was regulated if needed, intending unaltered serum TSH levels.

Evaluation: Tests for quality of life (QOL) and depression (SF-36, Beck Depression Inventory, and SCL- 90-R) at baseline and after both treatment periods.

Inclusion criteria: Serum TSH between 0.1 and 5.0 mU/l on unaltered T4 substitution for 6 months. Results: A total of 59 patients (55 women); median age 46 years. When comparing scores of QOL and depression on T4 monotherapy versus T4/T3 combination therapy, significant differences were seen in 7 out of 11 scores, indicating a positive effect related to the combination therapy. Forty-nine percent preferred the combination and 15% monotherapy (PZ0.002). Serum TSH remained unaltered between the groups as intended.

Conclusion: In a study design, where morning TSH levels were unaltered between groups combination therapy, (treated with T3 20 mg once daily) was superior to monotherapy by evaluating several QOL, depression and anxiety rating scales as well as patients own preference.

More recent research has been done, but don't have immediate access to it.