Thyroid UK
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Yet another Bianco review on T3 substitution

They are coming thick and fast! Another review by Bianco and coworkers on the need for T3 substitution in some subjects and the biochemistry of it. NB we've also got our Review in for consideration on the same topic. Strange Bianco never quotes us even though some of our work predates his. Now why is that do you think? Academic jealousy? Dogs in manger? Hmm.

Scope and limitations of iodothyronine deiodinases in hypothyroidism

Balázs Gereben, Elizabeth A. McAninch, Miriam O. Ribeiro and Antonio C. Bianco

Nat. Rev. Endocrinol. advance online publication 29 September 2015; doi:10.1038/nrendo.2015.155

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A link to the above paper :

People have to pay to read the whole paper, but the abstract and the references are freely available.


Pretty powerful statement I'd say. Can't wait until Diogenes and his colleagues get their Review published. PR


The coordinated expression and activity of the iodothyronine deiodinases regulate thyroid hormone levels in hypothyroidism. Once heralded as the pathway underpinning adequate thyroid-hormone replacement therapy with levothyroxine, the role of these enzymes has come into question as they have been implicated in both an inability to normalize serum levels of tri-iodothyronine (T3) and the incomplete resolution of hypothyroid symptoms. These observations, some of which were validated in animal models of levothyroxine monotherapy, challenge the paradigm that tissue levels of T3 and thyroid-hormone signalling can be fully restored by administration of levothyroxine alone. The low serum levels of T3 observed among patients receiving levothyroxine monotherapy occur as a consequence of type 2 iodothyronine deiodinase (DIO2) in the hypothalamus being fairly insensitive to ubiquitination. In addition, residual symptoms of hypothyroidism have been linked to a prevalent polymorphism in the DIO2 gene that might be a risk factor for neurodegenerative disease. Here, we discuss how these novel findings underscore the clinical importance of iodothyronine deiodinases in hypothyroidism and how an improved understanding of these enzymes might translate to therapeutic advances in the care of millions of patients with this condition.

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Since this paper is not readily available, I've sent it in full open form to Louise Warvill, with whom you can coordinate accessibility.


You want to read this paper, it is Dr. Bianco's Review of what they have learned so far.

Things will not change tomorrow but at least we have two research teams that are contributing intelligent science and a clearer understanding of how the greater thyroid system works. PR




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