(Oops! They did it again.)

The editors of the latest research on the controversial subject of combination therapy (t4 plus t3) for treating hypothyroidism have missed the point again.

A recent article published in the Annals of Internal Medicine (March 15, 2005) attempted to answer the question about whether combining t3 (Cytomel) with t4 (Synthroid, Levoxyl, Levothroid) for treating under active thyroid (hypothyroidism) produces a better outcome than using t4 alone.

Although the latest studies of this controversy lump all hypothyroid patients together, the most recent one showed an impressive preference for combination therapy by 18 of the 28 patients who got t3 added to their conventional t4. And this happened without adjustment of t3 dosing which is often required for the best results.

I was excited and impressed with these results. But guess how the editors who published this study interpreted these results? With a dry and simple statement that dismissed these findings as showing “no difference” between combination treatment and treatment with t4 alone. They concluded by stating that treatment with t4 alone is “sufficient”, leaving one to conclude that adding t3 produces no benefits. I have to scratch my head in wonder.

What could explain the resistance of these experts to see combination t3 and t4 as an exciting improvement in treatment of hypothyroidism? Perhaps it is the old bias against combination t3 and t3 products. These products which include names like Proloid were withdrawn from the market decades ago. How can we physicians rationalize our abandonment of combination hormone treatment leaving our patients to struggle on their own with their symptoms? By denying that in many cases combination treatment can be superior we can avoid having to deal with this failure of our accepted teachings.

For now each hypothyroid patient must decide with their own physician whether combination therapy is right for them. Keep an eye on metabolism.com for more updates on the latest in this debate.