A very disappointing paper. My summary: a bit of T3 seems to help quite a number of people but let us not give it in case it has some risk. I still argue that it is for the patient to choose between say, 30 years of reasonable health and well-being or 40 of suffering. Of course, the question (and answer) is never quite as simple as that. And in evidence-based medicine, surely it should be necessary to show that adding T3 is a worse option and not simply saying that because they don't know for certain, you can't.
If you are interested, these authors have published papers questioning T4 monotherapy over several years.
Best Pract Res Clin Endocrinol Metab. 2015 Jan;29(1):57-75. doi: 10.1016/j.beem.2014.10.004. Epub 2014 Oct 25.
Treatment of hypothyroidism with levothyroxine or a combination of levothyroxine plus L-triiodothyronine.
Escobar-Morreale HF1, Botella-Carretero JI2, Morreale de Escobar G3.
At present, the drug of choice for the treatment of hypothyroidism is levothyroxine sodium, even though the thyroid gland secretes both thyroxine and 3',3,5-triiodothyronine; the latter is the more active of the two at the cellular level because of its higher affinity for the nuclear thyroid hormone receptors. To date, combined levothyroxine plus liothyronine treatment for hypothyroidism has been evaluated in 15 clinical trials in humans. In two studies, combined therapy seemed to have beneficial effects on mood, quality of life, and psychometric performance of patients, compared with levothyroxine alone; in some of these studies, the patients preferred levothyroxine plus liothyronine combinations. This preference should be balanced against the possibility of adverse events resulting from the addition of liothyronine to levothyroxine. Until clear advantages of levothyroxine plus liothyronine are demonstrated, the administration of levothyroxine alone should remain the treatment of choice for replacement therapy of hypothyroidism.
Copyright © 2014 Elsevier Ltd. All rights reserved.
combined therapy; hypothyroidism; levothyroxine; liothyronine; replacement
[PubMed - as supplied by publisher]