Newly published paper. Conclusion: Significant benefit and, as ever, more research needed.
No-one can ever again legitimately say "There is no evidence..."
Note: Paper by authors from from Wales, England, Mexico and Denmark.
Int J Clin Pract
. 2021 Oct 9;e14967.
doi: 10.1111/ijcp.14967. Online ahead of print.
Is there a role for Natural Desiccated Thyroid in the treatment of levothyroxine unresponsive hypothyroidism? Results from a Consecutive Case Series
Adrian H Heald 1 2 , Lakdasa Premawardhana 3 , Peter Taylor 3 , Onyebuchi Okosieme 3 , Tasneem Bangi 2 , Holly Devine 2 , Mark Livingston 4 , Ahmed Javed 2 , Gabriela Y C Moreno 5 , Torquil Watt 6 , Mike Stedman 7 , Colin Dayan 3 , Dyfrig A Hughes 8
• PMID: 34626513
• DOI: 10.1111/ijcp.14967
Introduction: Some levothyroxine unresponsive individuals with hypothyroidism are prescribed a Natural Desiccated Thyroid (NDT) preparation such as Armour Thyroid® or ERFA Thyroid® . These contain a mixture of levothyroxine and liothyronine in a fixed ratio. We evaluated the response to NDT in individuals at a single endocrine centre in terms of how the change from levothyroxine to NDT impacted on their lives in relation to quality of life (QOL) and thyroid symptoms.
Methods: The ThyPRO39 (thyroid symptomatology) and EQ-5D-5L-related QoL)/EQ5D5L (generic QOL) questionnaires were administered to 31 consecutive patients who had been initiated on NDT, before initiating treatment/6 months later.
Results: There were 28 women and 3 men. The dose range of NDT was 60mg-180mg daily. Age range was 26-77 years with length of time since diagnosis with hypothyroidism ranging from 2-40 years. One person discontinued the NDT because of lack of response; 2 because of cardiac symptoms. EQ-5D-5L utility increased from a mean (SD) of 0.214 (0.338) at baseline, to 0.606 (0.248) after 6 months; corresponding to a difference of 0.392 (95% CI 0.241-0.542), t=6.82, p<0.001. EQ-VAS scores increased from 33.4 (17.2) to 71.1 (17.5), a difference of 37.7 (95%CI 25.2-50.2), t=-4.9, p<0.001. ThyPRO scores showed consistent fall across all domains with the composite QoL-impact Score improving from 68.3 (95%CI 60.9-75.7) to 25.2 (95%CI 18.7-31.7), a difference of 43.1 (95%CI 33. -53.2) (t=5.6, p<0.001).
Conclusion: Significant symptomatic benefit and improvement in QOL was experienced by people with a history of levothyroxine unresponsive hypothyroidism treated with NDT, suggesting the need for further evaluation of NDT in this context.
Keywords: NDT; free T3; free T4; levothyroxine; liothyronine; quality of life.
As so often, full paper is behind a paywall.