I just thought I'd display a typically useless trial that seeks to discover if combination treatment is superior to T4 only. The trial selects only 32 patients at random. Knowing 85-90% will be satisfactory on T4 only, then only 3-4 could possibly benefit at random. Far too small a number to be detected. This is just one more example of the lack of understanding of medical researchers on this topic, which has been repeated again and again.
Treatment of hypothyroidism with levothyroxine plus liothyronine: A randomized, double-blind, crossover study
Article in Arquivos brasileiros de endocrinologia e metabologia 60:1-11 · December 2016
DOI: 10.1590/2359-3997000000192
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diogenes
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I can't seem to access the full paper, but I'm wondering - do they also give every subject the same amount of T3? I'm just in the process of writing to the BTA to have a rant (not that I expect them to take any notice, but it will give me some satisfaction) and I'm pointing out to them that this is one of the faults in this kind of research.
They will never prove the benefits if they give everyone the same amount, even if they have a suitable group!
All this thyroid business will be the death of me - if they don't get me with inadequate treatment, or making me source T3 on the internet with all the risks that carries - then they'll kill me by all the stress it causes (and risk of heart disease because of it)!!!
Assuming it's the Kaminski paper: "Participants received capsules containing either their usual dose of LT4 (125 μg or 150 μg; Euthyrox, Merck S/A, Brazil) or LT4/LT3
(75 μg of LT4, plus 15 μg of LT3;"
125 μg or 150 μg of L-T4 was replaced with a dose of 75 μg L-T4 + 3 x 15 μg L-T3 which is equivalent to 120 μg L-T4. So, those on 150 μg L-T4 would have been trialled on a reduced dose.
(L-T3 is about 3x as potent as L-T4, see ncbi.nlm.nih.gov/pmc/articl... . These endocrinologists can't grasp pharmacokinetics, T3 may be 4x or 5x as potent in the blood but when taken as tablets you have to allow for absorption and elimination half-lives). So much for peer review.
Not to mention the fact that you cannot just flip a dose or a brand of any of this medication - I spent a couple of years trying to find a brand of Levo which suited me (after a good brand got discontinued). I did not succeed, they all made me feel ill and every time I switched to try a different brand I felt "deadly" before I improved to "terrible". Each switch was a two or three month trial and none of it would be considered something that could be measured as a true observation. I am great now on NDT.
Indeed... Such incompetent ignorant and egotistical useless endos! To add insult to injury they persist in telling us they know how to treat thyroid dysfunctions... No surprise we patients have had more than enough of this utter lack of talent and ability.
Yup, by selecting from the total Hypothyroid community, the 80-95% of people who respond well to thyroxine (T4) alone (lucky them!!) will ALWAYS dilute any data about those 5-20% of people who do NOT respond well to T4 (or a mix of T4 /T3, or just plain T3 as is the case for me And Yes Diogenes, the sample size of the few that are unwell on T4 alone, is then just too small to be statistically significant. My endo was just saying last week that funding is needed to study a large group of the 5-20% who are not doing well on just T4. If I won the lottery, I would invest in this area of research pronto!!
And... the vast majority of people who suffer from Hypothyroidism are WOMEN and very few research programs take this into account when selecting subjects to study. And if you think women respond to medication exactly the same as men do, think again. We are physiologically different and this is not reflected in common research practices. Here’s an Australian ABC radio podcast you might find interesting, enlightening and infuriating
Blue_Bee, thanks for the link, quite an interesting show. A couple of years ago the NIH, here in the US, realized that men and women are different, who knew. Hopefully we will see a much needed change in research although it appears to be happening slowly.
A link to the page about the show. Gives a few more details about the people involved. PR
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And Yes Diogenes, the sample size of the few that are unwell on T4 alone, is then just too small to be statistically significant. My endo was just saying last week that funding is needed to study a large group of the 5-20% who are not doing well on just T4. If I won the lottery, I would invest in this area of research pronto!!
Dr changed t3/t4 dose? How do i do it? 
How do these bloods look? Early pregnancy and hashimotos
How do you look when hypothyroid
How do I start combining T3 with levothyroxine?
How do I take k2 separately? 
