This downloadable paper (I don't think I've posted this before, so apologies if I have) describes a trial of giving T3 to women patients with residual symptoms on T4 only.
Effect of Liothyronine Treatment on Quality of Life in Female Hypothyroid Patients With Residual Symptoms on Levothyroxine Therapy: A Randomized Crossover Study
February 2022Frontiers in Endocrinology 13:1
DOI: 10.3389/fendo.2022.816566
Effect of Liothyronine Treatment on Dermal Temperature and Activation of Brown Adipose Tissue in Female Hypothyroid Patients: A Randomized Crossover Study
Article
Full-text available
November 2021
Abstract Objective The effects of levothyroxine (LT4)/liothyronine (LT3) combination therapy on quality of life (QoL) in hypothyroid patients former on LT4 monotherapy have been disappointing. We therefore wanted to test the effects of LT3 monotherapy on QoL in hypothyroid patients with residual symptoms despite thyroid stimulating hormone (TSH) values within the reference range. Design Female hypothyroid patients with residual symptoms on LT4 monotherapy or combination LT4/LT3 therapy received LT3 and LT4 monotherapy, respectively for 12 weeks in a non-blinded randomized crossover study. Methods Fifty-nine patients aged 18-65 years were included. QoL was assessed using one disease-specific questionnaire (ThyPRO) and two generic questionnaires (Fatigue Questionnaire and SF-36) at baseline and at the end of the two treatment periods. Clinical indices of cardiovascular health (resting heart rate and blood pressure), as well as thyroid tests, were assessed at baseline and at the end of the two treatment periods. Results After 12 weeks of LT3 treatment, 12 of the 13 domains of the ThyPRO questionnaire (physical, mental and social domains) showed significant improvements. The most pronounced improvements were less tiredness (mean -21 ± 26; P <0.0001) and cognitive complaints (mean -20 ± 20; P <0.0001). LT4 monotherapy exerted minor effects on two domains only (cognitive complaints and impaired daily life). All three dimensions’ scores in the Fatigue Questionnaire (physical, mental and total fatigue) improved after LT3 treatment compared to baseline ( P <0.001), and in the SF-36 questionnaire 7 of 8 scales showed significantly better scores after LT3 treatment compared to baseline. There were no differences in blood pressure or resting heart rate between the two treatment groups. TSH in patients on LT3 was slightly higher (median 1.33 mU/L (interquartile range (IQR) 0.47-2.26)) than in patients on LT4 (median 0.61 mU/L (IQR 0.25-1.20; P <0.018). Five patients on LT3 dropped out of the study due to subjectively reported side effects, compared to only one on LT4. Conclusions LT3 treatment improved QoL in women with residual hypothyroid symptoms on LT4 monotherapy or LT4/LT3 combination therapy. Short-term LT3 treatment did not induce biochemical or clinical hyperthyroidism, and no cardiovascular adverse effects were recorded. Further studies are needed to assess the long-term safety and efficacy of LT3 monotherapy. Clinical Trial Registration ClinicalTrials.gov , identifier NCT03627611.
Written by
diogenes
Remembering
To view profiles and participate in discussions please or .
Interesting, thanks for posting. I do think they have to do longer-term studies as 12 weeks really isn't very long. Still, that looks positive for T3 therapy. Certainly when I went onto T3 only the very first thing I noticed was a marked improvement in my ability to concentrate, this has improved slowly over time. I wish, though, that it was only 'residual' symptoms T3 was removing, rather than 'all' ! I still have the majority of hypo symptoms 5 years on from subclinical hypo diagnosis, despite being on Levo monotherapy, then changing to T3 monotherapy. I have recently tried adding in a bit on T4 again, but really there's no change. The main improvement for me from adding T3 is getting my brain back again. So worth it from that point of view if nothing else!
Agree regarding the timescale, it was only when I had been on a stable dose for 3 months that I stared to feel properly better, so that was getting on for 5-6 months after I started taking T3. I suppose any positive news is better than none though.
Thanks for posting diogenes. I had horrible experience on T4 but T3 resolved all of the awful symptoms and severe palpitations also ceased too. My heart became calm.
Is there a reason why there is a flurry of papers on hypothyroidism? Is there a recognition that more needs to be done to help people who appear to be adequately, and possibly even optimally, medicated but who still have a slew of symptoms?
I'll put it as frankly as I can. Up until now, and still adhered to, the classical description of hypothyroidism in the UK assumes that hypothyroidism and its alleviation are simply mirror images of what happens in health. The thyroid is gone, so it's a simple matter of giving the T4 back by mouth, when the status quo re FT4 and TSH is restored. This isn't so, but the UK endocrinologists refuse to believe that their idea is wrong. I won't go into detail, but the thyroid is an important producer of T3 as well as T4, and glandular loss has more implications than merely considering T4 loss. The US endocrinoloogists led by the vigorous Bianco have realised that the current regimen of giving T4 only does not solve many patients' problems and they are looking more closely at combination therapy to explain things and have admitted the failure of past clinical trials to uncover this. This has led into the current unstable state of affairs, where it's now admitted combination therapy can be superior, but not yet how, where and how frequently. So we have a bandwagon effect that has recently emerged, where, outside the UK and other recalcitrant nations, the advantages of combination therapy are being uncovered. I forecast a complete paper deluge in the coming year or two. I feel the NHS attitude of endocrinologists here makes them a) unduly cautious b) unwilling to move unless all do and c) suspicious of anything they haven't thought of. I omit NDT for other reasons which are faulty but would take a lot of time to argue about.
That’s really interesting. Bianco is leading the charge. I tried adding some T3 a couple of years ago, under the supervision of an endocrinologist, but I didn’t notice any difference. Your sentence that says “how, where and how frequently” gives me some hope that maybe I might try again when some of those questions have better answers.
If you want an example of NHS groupthink, then today's Sunday Times has a corruscating article on the harm groupthink caused in the unnecessary deaths of babies in Shropshire. It's all of a kind permeating the NHS.
Thanks Diogenes. I’ll have a read of that. Some of the group think is centrally controlled. This is especially true of T3 I think because of the unnecessarily high cost of liothyronine.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
2022 'T3 only' crossover study (compared to Levo only) shows good results .
