Adding carbimazole to levothyroxine increases triiodothyronine and improves outcome in patients with primary hypothyroidism

[helvella]

Just looking up something else, I happened upon this paper.

I was somewhat surprised by the clear recognition of levothyroxine issues in BACKGROUND.

If the CONCLUSIONS are valid, this very much needs some explanation.

Note: The number of subjects is tiny. Usually this makes a paper look unreliable, but even a single subject having a positive result is of potential interest.

Electron Physician. 2017 Feb 25;9(2):3706-3713. doi: 10.19082/3706. eCollection 2017 Feb.

Adding carbimazole to levothyroxine increases triiodothyronine and improves outcome in patients with primary hypothyroidism: a preliminary study from Egypt.

Elfayoumy KN1, Elgazzar UB2, Aboalabbas M3, Al-Adl AS1.

Author information

1 Internal Medicine Department, Faculty of Medicine, Al-Azhar University, New Damietta, Damietta, Egypt.

2 Biochemistry Department, Faculty of Medicine, Al-Azhar University, New Damietta, Damietta, Egypt.

3 Psychiatry Department, Faculty of Medicine, Al-Azhar University, New Damietta, Damietta, Egypt.

Abstract

BACKGROUND:

Many hypothyroid patients are not tolerant and not satisfied with levothyroxine (LT4). Older studies used large doses of both carbimazole and LT4 for Hashimoto's thyroiditis (HT), because Graves' disease (GD) and HT were considered as very closely related syndromes produced by thyroid autoimmunity.

OBJECTIVE:

The aim of the study was to determine the outcome after adding small doses of carbimazole to reduced doses of LT4 for patients with primary hypothyroidism, who are unable to tolerate LT4.

METHODS:

The study is a non-randomized, single arm, interventional study. It included 19 female patients diagnosed with primary hypothyroidism who could not tolerate LT4. Subjects were recruited from the outpatient clinic of AL-Azhar University Hospital in Damietta, Egypt from January to March 2015. They were divided into two groups; group 1 included 10 patients with HT and 2 patients with non-specified primary hypothyroidism, and group 2 included 7 patients with subtotal thyroidectomy for GD. All patients received carbimazole (10 mg/day) beside LT4 (25 μg thrice/week) for 10 weeks. Statistical analysis of the data was done by SPSS version 20, using paired-sample t-test, ANOVA, Chi square, and Pearson coefficient test.

RESULTS:

There was significant increase in free triiodothyronine (FT3) in addition to significant improvement in depression and LT4 tolerance in the whole population. There was non-significant improvement in TSH in group 1 (p=0.053). Surprisingly, in group 2, in spite of significant increase in TSH (p=0.007) and non-significant decrease in free thyroxine (FT4), there was non-significant increase in FT3. Whether carbimazole improves the pathology of the hypothyroid gland or the peripheral deiodination of T4 to T3 (where the serum and tissue levels of the latter may be responsible for improvement of symptoms) is in need of investigation.

CONCLUSIONS:

Adding carbimazole to LT4 improves FT3, LT4 tolerance, and depression in primary hypothyroid female patients. Further studies are required to determine the appropriate doses of this regimen in different cases.

CLINICAL TRIAL REGISTRATION:

This study was registered at Thai Clinical Trials Registration center (clinicaltrials.in.th) with registration ID: TCTR20170123003.

FUNDING:

The study received no fund or grant.

KEYWORDS:

Carbimazole; Levothyroxine; Primary hypothyroidism; Triiodothyronine

PMID: 28465796

PMCID: PMC5410895

DOI: 10.19082/3706

ncbi.nlm.nih.gov/pubmed/284...

Full paper freely available here:

ncbi.nlm.nih.gov/pmc/articl...

[linda96]

I came across that Egyptian paper myself a short while ago. I have wondered why more had not been made of its findings.

[helvella Administrator in reply to linda96]

It sometimes looks as if the papers that get quoted are the ones that do not rock any boats.

[linda96 in reply to helvella]

Yes, not rocking the boat; more kudos; attracting grant funding for future projects.

[HowCome]

Thankyou helvella

[SlowDragon Administrator]

How fascinating......if we can't get prescribed T3 perhaps should be asking for carbimazole instead!!!

[Mamapea1 in reply to SlowDragon]

I can just imagine the conversation with my GP...she would be speed writing prescriptions for antidepressants! 😂

[Hillwoman]

Very interesting indeed, but I'm scratching my head... If the 'extra' T3 comes from improved peripheral deiodination, this is potentially very promising

.

[Hidden]

That is amazing. Thank you Helvella

It seems strange that the same medication can help conditions with opposite symptoms. But of course they are both autoimmune conditions, so maybe it somehow helps decrease the autoimmunity itself.

Maybe the article explains that. It's too late to read it tonight but will definitely have a go tomorrow.

[Clara62]

Interesting!

[SlowDragon Administrator]

Been thinking about this ........it may be a red herring

Carbimazole may be just slowing the rate of use of limited (inadequate dose) of Levothyroxine.

I had similar treatment using propranolol plus Levothyroxine for almost 20 years. Propranolol was the only way I could tolerate dose of Levothyroxine higher than 75mcg. (I needed 125mcg) Propranolol made my thyroid results look "perfect" ..... FT3 rose........but I was still very hypo. No energy, terrible mucin, massive weight gain etc

Only regained full health joining here....seeing how common gluten intolerance was. Once strictly gluten free I was slowly able to stop propranolol. Correcting low vitamins by significant supplements and adding small dose of T3.

So I suggest the carbimazole may be a similar "sticking plaster" like propranolol ....but not a cure of common root problems of too little replacement Levothyroxine or need of addition of T3 and/or low vitamins and/or food intolerances

[helvella Administrator in reply to SlowDragon]

I agree that it could well be a red herring.

The observation is interesting even if it has no possible use in real-world treatment.

[Celestialbeing]

Very interesting! I wonder how it would work for/affect people that lost their thyroids to cancer and do not have issues with AI , gluten, folic acid, MTHFR gene (single or double). I know for me, synthetic T4/T3 did not help me. I did not properly convert the synthetic T4, did not process the T3 and the T3 caused more side effects. When I switched to desiccated T4/T3 was when I felt almost human and had better results.

[Hillwoman in reply to Celestialbeing]

It seems the bound hormone in NDT is processed more efficiently by many people than the free hormone in synthetic thyroid replacement.