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Laura Paone, Abby F Fleisch, Henry A Feldman, Rosalind S Brown, Ari J Wassner
OBJECTIVE: To assess whether adding liothyronine (LT3) to levothyroxine (LT4) monotherapy normalizes serum thyrotropin (TSH) and thyroxine (T4) concentrations in children with congenital hypothyroidism and central resistance to thyroid hormone. STUDY DESIGN: We retrospectively studied 12 patients with congenital hypothyroidism and central resistance to thyroid hormone (6 treated with LT3+LT4 combined therapy and 6 treated with LT4 monotherapy). In patients receiving combined therapy, we compared serum concentrations of TSH, T4, and triiodothyronine before and after addition of LT3...
August 2016: Journal of Pediatrics
Jacqueline Jonklaas
INTRODUCTION: Hypothyroidism is currently a condition that can be treated, but not cured. Although levothyroxine reverses stigmata of hypothyroidism in most individuals, some patients feel dissatisfied with 'monotherapy', and this has stimulated interest in 'combination therapy' with both levothyroxine and liothyronine. AREAS COVERED: A search of PubMed was conducted using terms including hypothyroidism, treatment, benefits, risks, and safety. Based on the articles identified, the body of evidence regarding the efficacy of traditional levothyroxine is reviewed...
August 2016: Expert Review of Clinical Pharmacology
V Eligar, P N Taylor, O E Okosieme, G P Leese, C M Dayan
BACKGROUND: Hypothyroidism affects 2-5% of the general population. Patients with uncorrected disease suffer significant morbidity and have an increased risk of cardiovascular disease and neurocognitive impairment. Levothyroxine, the treatment of choice, is inexpensive, easy to administer and in most cases restores well-being while normalizing thyroid function. However, 30-50% of individuals on levothyroxine are either over-treated or under-treated and others remain dissatisfied with treatment despite achieving thyroid hormone concentrations within the laboratory reference interval...
July 2016: Annals of Clinical Biochemistry
Jacqueline Jonklaas, Kenneth D Burman
BACKGROUND: Although most studies of levothyroxine-liothyronine combination therapy employ once-daily hormone administration, the kinetics of once-daily liothyronine have been studied infrequently. The aim of this study was to document both the peak and trough serum triiodothyronine (T3) levels that occur with once-daily liothyronine administration, along with changes in thyroid-responsive parameters. METHODS: Participants with hypothyroidism were studied prospectively at an academic institution...
June 2016: Thyroid: Official Journal of the American Thyroid Association
Pierpaolo Trimboli, Marco Centanni, Camilla Virili
In the last ten years a liquid formulation of liothyronine (L-T3) became available. To date, no studies on its systematic use have been reported. This study is aimed at assessing the reliability of liquid L-T3 in achieving target TSH in patients with differentiated thyroid cancers (DTC). Twenty-one high risk DTC patients in whom levothyroxine treatment up to 2.0 μg/kg/day did not suppress TSH levels (i.e. >0.1 mIU/L) were selected. Maintaining the same L-T4 dose, they started to assume liquid L-T3 at an initial fixed dose of 3...
June 30, 2016: Endocrine Journal
Graham P Leese, Enrique Soto-Pedre, Louise A Donnelly
OBJECTIVE: To look at adverse outcomes for patients on liothyronine compared to l-thyroxine. Some trials have examined the relative merits of liothyronine but none have looked at adverse outcomes in large numbers STUDY DESIGN: An observational study of all patients prescribed thyroid hormone replacement in Tayside Scotland (population 400,000) from 1997 to 2014. PATIENTS: A study group of patients having ever used liothyronine (n=400) was compared to those who had only used l-thyroxine (n=33,955)...
March 4, 2016: Clinical Endocrinology
Eyal Kraut, Pendar Farahani
PURPOSE: Patients with hypothyroidism are increasingly enquiring about the benefit of using combination therapy of levothyroxine (LT4) and liothyronine (LT3) as a potential treatment for hypothyroidism. Combination therapy, however, remains controversial. The purpose of this study was to systematically review available hypothyroidism treatment recommendations from clinical practice guidelines from around the world to identify the consensus regarding combination therapy. SOURCE: Clinical practice guidelines were obtained from searches of PubMed, EMBASE, and MEDLINE, using several combinations of MeSH terms...
2015: Clinical and Investigative Medicine. Médecine Clinique et Experimentale
Peter N Taylor, Arshiya Tabasum, Gina Sanki, David Burberry, Brian P Tennant, James White, Onyebuchi Okosieme, Andrew Aldridge, Gautam Das
An 82-year-old female with known hypothyroidism was admitted to hospital after being found on the floor. On examination, she was unkempt, confused, bradycardic, hypothermic, and barely arousable. Initial biochemistry revealed a thyroid stimulating hormone (TSH) of >100 mU/L and free thyroxine (FT4) level of 1.5 pmol/L which supported a diagnosis of myxoedema coma. She was resuscitated and commenced on liothyronine, levothyroxine, and hydrocortisone and some improvement was made. It became apparent that she was hiding and spitting out her oral levothyroxine including levothyroxine elixir...
2015: Case Reports in Endocrinology
Luba Freja Michaelsson, Bjarke Borregaard Medici, Jeppe Lerche la Cour, Christian Selmer, Michael Røder, Hans Perrild, Nils Knudsen, Jens Faber, Birte Nygaard
BACKGROUND: Five to ten percent of patients with hypothyroidism describe persistent symptoms despite being biochemically well regulated on levothyroxine (L-T4). Thyroxine (T4)/triiodothyronine (T3) combination therapy [L-T4/liothyronine (L-T3) or desiccated thyroid] are still regarded as experimental with no evidence of superior effect on persistent symptoms according to meta-analyses. However, some randomized controlled trials have demonstrated patients' preference for T4/T3 combination therapy as compared to L-T4 monotherapy...
September 2015: European Thyroid Journal
Jacqueline Jonklaas
PURPOSE OF REVIEW: Differentiated thyroid cancer is a malignancy that is rapidly increasing in frequency. As thyroidectomy plays a central role in the treatment of thyroid cancer, it is incumbent on physicians treating this patient group to be well versed in the intricacies of treating hypothyroidism. RECENT FINDINGS: Treatment of hypothyroidism may be refined by careful attention to dose selection, monitoring of therapy and achievement of thyrotropin goals that are specific to the individual patient's overall clinical situation...
January 2016: Current Opinion in Oncology
Megan E Foeller, Robert M Silver
Hypothyroidism is one of the most common endocrine disorders in young women and affects 3% to 4% of all pregnancies. Inadequately treated maternal hypothyroidism is associated with numerous adverse fetal and maternal outcomes. Because of growing popularity of levothyroxine (L-T4) + liothyronine (L-T3) combination therapy for hypothyroidism in nonpregnant individuals, pregnant women are taking these medications with increasing frequency. This article reviews the theoretical dangers of combination L-T4 + L-T3 treatment during pregnancy by outlining physiological regulation of maternal and fetal thyroid homeostasis, proposed adverse fetal outcomes to combination therapy, and current recommendations on thyroid replacement in pregnancy from professional societies...
September 2015: Obstetrical & Gynecological Survey
Yun Zeng, Yimin Xu, Chee-Leong Kee, Min-Yong Low, Xiaowei Ge
In this study, a liquid chromatography-tandem mass spectrometry (LC-MS/MS) with scheduled multiple reaction monitoring (MRM) enhanced product ion (EPI) method was developed for simultaneous determination of 40 compounds with weight loss effect, including bisacodyl, phenolphthalein, and sibutramine and its metabolites, etc. They might be adulterated in health supplements to get prominent weight loss effect. The samples were analyzed using a Q-Trap 5500 coupled with high performance liquid chromatography (HPLC) and a CORTECS ultra performance liquid chromatography (UPLC) C18 column (100 mm x 2...
March 2016: Drug Testing and Analysis
Lauren MacLeod Linder, Jennifer N Clements
Levothyroxine is the first-line drug for treating hypothyroidism. This article reviews the literature on combination therapy using levothyroxine and liothyronine, and found that only one study produced beneficial outcomes; other studies reported increased adverse reactions among participants. Levothyroxine should remain the drug of choice for hypothyroidism. Adequate trials with homogenous populations and large sample sizes are needed to determine whether combination therapy can be recommended for patients with hypothyroidism...
September 2015: JAAPA: Official Journal of the American Academy of Physician Assistants
James V Hennessey
OBJECTIVE: To describe the history, refinements, implementation, physiology, and clinical outcomes achieved over the past several centuries of thyroid hormone replacement strategies. METHODS: A Medline search was initiated using the following search terms: bioidentical thyroid hormone, thyroid hormone extract, combination thyroxine (T4) and tri-iodothyronine (T3) therapy, homeopathic thyroid hormone therapy, and thyroid hormone replacement. Pertinent articles of interest were identified by title (and where available abstract) for further review...
October 2015: Endocrine Practice
Arash Mohagheghi, Asghar Arfaie, Shahrokh Amiri, Masoud Nouri, Salman Abdi, Salman Safikhanlou
Introduction and Objective. Despite the effectiveness of electroconvulsive therapy (ECT) in treating major depressive disorder (MDD), its cognitive side effects make it less popular. This study investigated the impact of liothyronine on ECT-induced memory deficit in patients with MDD. Methodology. This is a double-blind clinical trial, in which 60 patients with MDD who were referred for ECT were selected. The diagnosis was based on the criteria of DSM-IV-TR. Patients were divided randomly into two groups to receive either liothyronine (50 mcg every morning) or placebo...
2015: BioMed Research International
Ajay Bains, Ami-Joseph Brosseau, David Harrison
No abstract text is available yet for this article.
January 2015: Canadian Journal of Hospital Pharmacy
Andreas Jurik, Barbara Zdrazil, Marion Holy, Thomas Stockner, Harald H Sitte, Gerhard F Ecker
Elevating GABA levels in the synaptic cleft by inhibiting its reuptake carrier GAT1 is an established approach for the treatment of CNS disorders like epilepsy. With the increasing availability of crystal structures of transmembrane transporters, structure-based approaches to elucidate the molecular basis of ligand-transporter interaction also become feasible. Experimental data guided docking of derivatives of the GAT1 inhibitor tiagabine into a protein homology model of GAT1 allowed derivation of a common binding mode for this class of inhibitors that is able to account for the distinct structure-activity relationship pattern of the data set...
March 12, 2015: Journal of Medicinal Chemistry
Héctor F Escobar-Morreale, José I Botella-Carretero, Gabriella Morreale de Escobar
At present, the drug of choice for the treatment of hypothyroidism is levothyroxine sodium, even though the thyroid gland secretes both thyroxine and 3',3,5-triiodothyronine; the latter is the more active of the two at the cellular level because of its higher affinity for the nuclear thyroid hormone receptors. To date, combined levothyroxine plus liothyronine treatment for hypothyroidism has been evaluated in 15 clinical trials in humans. In two studies, combined therapy seemed to have beneficial effects on mood, quality of life, and psychometric performance of patients, compared with levothyroxine alone; in some of these studies, the patients preferred levothyroxine plus liothyronine combinations...
January 2015: Best Practice & Research. Clinical Endocrinology & Metabolism
Jacqueline Jonklaas, Antonio C Bianco, Andrew J Bauer, Kenneth D Burman, Anne R Cappola, Francesco S Celi, David S Cooper, Brian W Kim, Robin P Peeters, M Sara Rosenthal, Anna M Sawka
BACKGROUND: A number of recent advances in our understanding of thyroid physiology may shed light on why some patients feel unwell while taking levothyroxine monotherapy. The purpose of this task force was to review the goals of levothyroxine therapy, the optimal prescription of conventional levothyroxine therapy, the sources of dissatisfaction with levothyroxine therapy, the evidence on treatment alternatives, and the relevant knowledge gaps. We wished to determine whether there are sufficient new data generated by well-designed studies to provide reason to pursue such therapies and change the current standard of care...
December 2014: Thyroid: Official Journal of the American Thyroid Association
Sang Hyun Lee, Jin Gu Kang, Moon Chol Hahm, Jeong Heon Park, Kyung-Mi Kim, Tae-Wan Lim, Young Ri Kim
We report an anesthetic experience in a clinically euthyroid patient with hyperthyroxinemia (elevated free thyroxine, fT4 and normal 3, 5, 3'-L-triiodothyronine, T3) and suspected impairment of conversion from T4 to T3. Despite marked hyperthyroxinemia, this patient's perioperative hemodynamic profile was suspected to be the result of hypothyroidism, in reference to the presence of T4 to T3 conversion disorder. We suspected that pretreatment with antithyroid medication before surgery, surgical stress and anesthesia may have contributed to the decreased T3 level after surgery...
August 2014: Korean Journal of Anesthesiology
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