Replacement therapy with levothyroxine plus triiodothyronine (bioavailable molar ratio 14 : 1) is not superior to thyroxine alone to improve well‐being and cognitive performance in hypothyroidism

@article{Siegmund2004ReplacementTW,
  title={Replacement therapy with levothyroxine plus triiodothyronine (bioavailable molar ratio 14 : 1) is not superior to thyroxine alone to improve well‐being and cognitive performance in hypothyroidism},
  author={W Siegmund and K Spieker and Almut I. Weike and Thomas Giessmann and Christiane Modess and Thomas Dabers and Gerhard Kirsch and E S{\"a}nger and Georg Engel and Alfons O. Hamm and Markus S. Nauck and W Meng},
  journal={Clinical Endocrinology},
  year={2004},
  volume={60}
}
objectives  There is evidence from recent controlled clinical studies that replacement therapy of hypothyroidism with T4 in combination with a small amount of T3 may improve the well‐being of the patients. As the issue is still the subject of controversial discussion, our study was assigned to confirm the superiority of a physiological combination of thyroid hormones (absorbed molar ratio 14 : 1) over T4 alone with regard to mood states and cognitive functioning. 
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Current evidence for the treatment of hypothyroidism with levothyroxine/levotriiodothyronine combination therapy versus levothyroxine monotherapy
TLDR
The evidence for and against LT4/LT3 combination therapy as the optimal approach to treat euthyroid patients with persistent complaints is explored.
The pharmacodynamic equivalence of levothyroxine and liothyronine: a randomized, double blind, cross‐over study in thyroidectomized patients
Context  The substitution of liothyronine (L‐T3) for levothyroxine (L‐T4) is commonly employed during thyroid hormone (TH) withdrawal in preparation for diagnostic and therapeutic interventions on…
Treatment of clinical hypothyroidism with thyroxine and triiodothyronine: a literature review and metaanalysis.
TLDR
A metaanalysis of the nine controlled studies examining the impact of combined thyroxine-plus-triiodothyronine versus thyroxin alone reveals no significant difference in treatment effect on psychiatric symptoms in theNine controlled studies to date.
T4 versus T3 and T4: Is It a Real Controversy?
  • A. Weetman
  • Medicine
    Hormone Research in Paediatrics
  • 2007
TLDR
Clinical studies that are adequately powered and comprised of homogenous patient populations are needed to determine whether any benefits are associated with sustained-release T3 preparations.
Triiodothyronine alongside levothyroxine in the management of hypothyroidism?
TLDR
A number of randomized, controlled trials have failed to demonstrate superiority for the combination therapy approach, largely due to non-physiological T3 doses, but patients with hypothyroidism are highly heterogeneous in terms of their residual thyroid function, individual set points for optimal thyroid homeostasis and for the presence or absence of polymorphisms in deiodinase enzymes.
Partial substitution of thyroxine (T4) with tri-iodothyronine in patients on T4 replacement therapy: results of a large community-based randomized controlled trial.
TLDR
These results may be consistent with a subgroup of patients showing transient improvement after partial substitution with T(3) but do not provide conclusive evidence of specific benefit from partial substitution of T(4) by T( 3) in patients on T( 4) replacement.
Do we need still more trials on T4 and T3 combination therapy in hypothyroidism?
  • W. Wiersinga
  • Biology, Medicine
    European journal of endocrinology
  • 2009
TLDR
Meta-analysis of randomized clinical trials shows no advantage of T(4)/tri-iodothyronine (T(3)) combination therapy over T( 4) monotherapy, and genetic polymorphisms in deiodinase 2 and thyroid hormone transporters have been associated with well-being, fatigue, depression, and greater improvement on combination therapy.
Thyroid hormone replacement for central hypothyroidism: a randomized controlled trial comparing two doses of thyroxine (T4) with a combination of T4 and triiodothyronine.
TLDR
Using a dose of 1.6 microg/kg bw improved markers commonly associated with central hypothyroidism, and suggests that T( 4) dosage based on bw and aiming at fT4 in the upper reference range is superior to titration of T(4) aiming at middle normal fT 4 concentrations in those patients.
Treatment of hypothyroidism with levothyroxine or a combination of levothyroxine plus L-triiodothyronine.
Thyroxine alone or thyroxine plus triiodothyronine replacement therapy for hypothyroidism.
TLDR
A systematic review of all included published, randomized controlled trials to evaluate the effects of thyroxin alone or thyroxine plus triiodothyronine replacement therapy for hypothyroidism found no significant statistical differences in biochemical variables, mood states clinical variables, adverse effects, and drop-out.
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