2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism.
| Title: | 2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism. |
|---|---|
| Authors: | Wiersinga WM; Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.; Duntas L; Endocrine Unit, Evgenidion Hospital, University of Athens Medical School, Athens, Greece.; Fadeyev V; Federal Endocrinological Scientific Center, Moscow, Russia.; Nygaard B; Department of Endocrinology, Herlev Hospital, Herlev, Denmark.; Vanderpump MP; Department of Endocrinology, Royal Free Hampstead NHS Trust, London, UK. |
| Source: | European thyroid journal [Eur Thyroid J] 2012 Jul; Vol. 1 (2), pp. 55-71. Date of Electronic Publication: 2012 Jun 13. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Bioscientifica Ltd Country of Publication: England NLM ID: 101604579 Publication Model: Print-Electronic Cited Medium: Print ISSN: 2235-0640 (Print) Linking ISSN: 22350640 NLM ISO Abbreviation: Eur Thyroid J Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Publication: 2022- : [Bristol] : Bioscientifica Ltd.; Original Publication: Basel : S. Karger |
| Abstract: | Background: Data suggest symptoms of hypothyroidism persist in 5-10% of levothyroxine (L-T4)-treated hypothyroid patients with normal serum thyrotrophin (TSH). The use of L-T4 + liothyronine (L-T3) combination therapy in such patients is controversial. The ETA nominated a task force to review the topic and formulate guidelines in this area.; Methods: Task force members developed a list of relevant topics. Recommendations on each topic are based on a systematic literature search, discussions within the task force, and comments from the European Thyroid Association (ETA) membership at large.; Results: SUGGESTED EXPLANATIONS FOR PERSISTING SYMPTOMS INCLUDE: awareness of a chronic disease, presence of associated autoimmune diseases, thyroid autoimmunity per se, and inadequacy of L-T4 treatment to restore physiological thyroxine (T4) and triiodothyronine (T3) concentrations in serum and tissues. There is insufficient evidence that L-T4 + L-T3 combination therapy is better than L-T4 monotherapy, and it is recommended that L-T4 monotherapy remains the standard treatment of hypothyroidism. L-T4 + L-T3 combination therapy might be considered as an experimental approach in compliant L-T4-treated hypothyroid patients who have persistent complaints despite serum TSH values within the reference range, provided they have previously received support to deal with the chronic nature of their disease, and associated autoimmune diseases have been excluded. Treatment should only be instituted by accredited internists/endocrinologists, and discontinued if no improvement is experienced after 3 months. It is suggested to start combination therapy in an L-T4/L-T3 dose ratio between 13:1 and 20:1 by weight (L-T4 once daily, and the daily L-T3 dose in two doses). Currently available combined preparations all have an L-T4/L-T3 dose ratio of less than 13:1, and are not recommended. Close monitoring is indicated, aiming not only to normalize serum TSH and free T4 but also normal serum free T4/free T3 ratios. Suggestions are made for further research.; Conclusion: L-T4 + L-T3 combination therapy should be considered solely as an experimental treatment modality. The present guidelines are offered to enhance its safety and to counter its indiscriminate use. |
| References: | J Clin Endocrinol Metab. 2006 Jul;91(7):2592-9. (PMID: 16670166); Eur J Endocrinol. 2011 May;164(5):781-8. (PMID: 21367965); JAMA. 2003 Dec 10;290(22):2952-8. (PMID: 14665656); J Clin Endocrinol Metab. 2003 Jun;88(6):2880-8. (PMID: 12788902); J Clin Endocrinol Metab. 2005 Feb;90(2):805-12. (PMID: 15585551); J Clin Endocrinol Metab. 2008 Jun;93(6):2300-6. (PMID: 18364382); Hormones (Athens). 2010 Jul-Sep;9(3):245-52. (PMID: 20688622); J Clin Endocrinol Metab. 2005 Aug;90(8):4946-54. (PMID: 15928247); Clin Endocrinol (Oxf). 2002 Nov;57(5):575-6. (PMID: 12390329); Eur J Endocrinol. 2009 Dec;161(6):895-902. (PMID: 19666698); J Clin Endocrinol Metab. 2009 Nov;94(11):4608-12. (PMID: 19820008); J Clin Endocrinol Metab. 2003 Oct;88(10):4543-50. (PMID: 14557419); Clin Endocrinol (Oxf). 2004 Jun;60(6):750-7. (PMID: 15163340); J Clin Endocrinol Metab. 2003 Oct;88(10):4551-5. (PMID: 14557420); Eur J Endocrinol. 2009 Dec;161(6):955-9. (PMID: 19808902); J Clin Endocrinol Metab. 2008 Aug;93(8):3075-81. (PMID: 18492748); Endocr Pract. 2002 Nov-Dec;8(6):457-69. (PMID: 15260011); Eur J Endocrinol. 2011 May;164(5):773-80. (PMID: 21317282); Nucl Med Commun. 2009 Aug;30(8):586-93. (PMID: 19491714); Am J Hum Genet. 2008 Jun;82(6):1270-80. (PMID: 18514160); J Clin Endocrinol Metab. 2006 Sep;91(9):3389-93. (PMID: 16804044); Thyroid. 2011 Feb;21(2):161-7. (PMID: 21186954); Endocrine. 2002 Jul;18(2):129-33. (PMID: 12374459); PLoS One. 2011;6(8):e22552. (PMID: 21829633); BMJ. 2003 Feb 8;326(7384):295-6. (PMID: 12574021); J Clin Endocrinol Metab. 2008 Mar;93(3):666-73. (PMID: 18171699); Br Med J. 1970 Oct 17;4(5728):145-8. (PMID: 4097650); Thyroid. 2011 Jun;21(6):593-646. (PMID: 21510801); Clin Endocrinol (Oxf). 2009 Aug;71(2):279-83. (PMID: 19018782); Arch Intern Med. 1990 Oct;150(10):2077-81. (PMID: 2222093); Clin Endocrinol (Oxf). 2009 Jun;70(6):954-60. (PMID: 18793344); Clin Endocrinol (Oxf). 1988 Mar;28(3):325-33. (PMID: 3139338); J Clin Endocrinol Metab. 2005 Nov;90(11):6296-9. (PMID: 16144953); Arch Intern Med. 2000 Feb 28;160(4):526-34. (PMID: 10695693); J Clin Endocrinol Metab. 2009 May;94(5):1623-9. (PMID: 19190113); Clin Endocrinol (Oxf). 2002 Nov;57(5):577-85. (PMID: 12390330); Clin Endocrinol (Oxf). 2009 Oct;71(4):574-80. (PMID: 19751298); J Clin Endocrinol Metab. 2005 May;90(5):2666-74. (PMID: 15705921); Endocr Pract. 2005 Jul-Aug;11(4):223-33. (PMID: 16006298); J Clin Endocrinol Metab. 2009 May;94(5):1521-3. (PMID: 19420275); Clin Endocrinol (Oxf). 2011 Apr;74(4):411-8. (PMID: 20718761); Thyroid. 1994 Spring;4(1):55-64. (PMID: 8054862); Endocr Rev. 2002 Feb;23(1):38-89. (PMID: 11844744); Ann Intern Med. 2005 Mar 15;142(6):412-24. (PMID: 15767619); JAMA. 1995 Mar 8;273(10):808-12. (PMID: 7532241); Thyroid. 2004 Apr;14(4):271-5. (PMID: 15142360); N Engl J Med. 1987 Mar 26;316(13):764-70. (PMID: 3821822); Eur J Endocrinol. 2005 Dec;153(6):747-53. (PMID: 16322379); J Clin Invest. 1995 Dec;96(6):2828-38. (PMID: 8675653); N Engl J Med. 1999 Feb 11;340(6):424-9. (PMID: 9971866); Nat Rev Endocrinol. 2009 Apr;5(4):211-8. (PMID: 19352319); JAMA. 2008 Feb 20;299(7):817-9. (PMID: 18285594); Wien Klin Wochenschr. 2005 Sep;117(18):636-40. (PMID: 16416346); Am J Physiol Endocrinol Metab. 2005 Jul;289(1):E75-81. (PMID: 15727947); Am J Med. 2010 Feb;123(2):183.e1-9. (PMID: 20103030); Clin Endocrinol (Oxf). 2006 Mar;64(3):231-3. (PMID: 16487429); Acta Endocrinol (Copenh). 1985 Dec;110(4):483-6. (PMID: 4090911); Exp Clin Endocrinol Diabetes. 2007 Apr;115(4):261-7. (PMID: 17479444); Am J Epidemiol. 2009 Mar 15;169(6):749-55. (PMID: 19224981); JAMA. 2008 Feb 20;299(7):769-77. (PMID: 18285588); Thyroid. 2004 Apr;14(4):247-8. (PMID: 15142357); J Clin Invest. 2006 Oct;116(10):2571-9. (PMID: 17016550); J Clin Endocrinol Metab. 2004 May;89(5):2507; author reply 2507-8. (PMID: 15126590); J Clin Endocrinol Metab. 1970 Jun;30(6):798-9. (PMID: 5444564); Endocrinology. 1996 Jun;137(6):2490-502. (PMID: 8641203); J Clin Endocrinol Metab. 2008 Mar;93(3):910-3. (PMID: 18073314); J Psychosom Res. 2005 Nov;59(5):263-8. (PMID: 16253615); Clin Endocrinol (Oxf). 2008 Nov;69(5):804-11. (PMID: 18410547); Am J Physiol. 1990 Apr;258(4 Pt 1):E715-26. (PMID: 2333963); Clin Endocrinol (Oxf). 2010 May;72(5):709-15. (PMID: 20447070); Thyroid. 2007 Mar;17(3):249-58. (PMID: 17381359); J Clin Endocrinol Metab. 1998 Sep;83(9):3194-7. (PMID: 9745425); J Clin Endocrinol Metab. 2006 Jul;91(7):2624-30. (PMID: 16670161); Chest. 2006 Jan;129(1):174-81. (PMID: 16424429) |
| Contributed Indexing: | Keywords: Combination therapy; Guidelines; Hypothyroidism; Thyroxine; Treatment; Triiodothyronine |
| Entry Date(s): | Date Created: 20140501 Date Completed: 20140430 Latest Revision: 20240518 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC3821467 |
| DOI: | 10.1159/000339444 |
| PMID: | 24782999 |
| Database: | MEDLINE |
Journal Article