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Therapy with thyroxine and triiodothyronine is not more effective than thyroxine alone in patients with hypothyroidism
The background of the study. Patients with hypothyroidism may not feel well despite treatment with thyroxine (T4) in doses that restore their serum T4 and thyrotropin (TSH) concentrations to normal. This has led to treatment with the combination of T4 and triiodothyronine (T3), but whether this is better is questionable. The results of the individual studies comparing the two treatments were analyzed in this study.
How the study was done. A search to identify randomized trials of T4 monotherapy and T4 and T3 combination therapy in patients with hypothyroidism yielded 11 studies. The design of each study; its characteristics; the details of patient selection, treatment doses, and end points evaluated; and the methods of analysis were summarized. The primary outcomes were bodily pain, fatigue, depression, and quality of life, as determined by the patients’ responses to questionnaires, which included the Short Form-36, Symptom Check List-90, Profile of Mood States Scale, Hospital Anxiety and Depression Scale, and Health-Related Quality-of-Life Scale.
The results of the study. The numbers of patients studied ranged from 26 to 607 (total, 1216). Most patients were women with hypothyroidism caused by chronic autoimmune thyroiditis. The duration of the studies ranged from 5 weeks to 9 months. In most studies, the daily dose of T4 during T4 monotherapy was that which the patient had been taking, and the daily doses during T4 and T3 combination therapy consisted of a lower dose of T4 and 10 to 25 µg of T3, yielding T4 to T3 ratios of 5:1 to 15:1.
There were no differences in the effects of T4 and T3 combination therapy and T4 monotherapy on bodily pain, fatigue, depression, or quality of life, or any of the other scores on the questionnaires. The serum TSH concentrations at the end of each treatment were similar in the two groups.
The conclusions of the study. T4 and T3 combination therapy is not more effective in ameliorating bodily pain, fatigue, and depression or improving quality of life than is T4 alone in patients with hypothyroidism.
The original article. Grozinsky-Glasberg S, Fraser A, Nahshoni E, Weizman A, Leibovici L. Thyroxine-triiodothyronine combination therapy versus thyroxine monotherapy for clinical hypothyroidism: meta-analysis of randomized controlled trials. J Clin Endocrinol Metab 2006;91:2592-9.
Next Article: Administration of thyroxine into the amniotic fluid is effective therapy for goiter and hypothyroidism in fetuses |
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| Thyroid Digest Index | | | November 2006 Thyroid Digest |
