A Wrong Turn in the Treatment of Hypothyroidism?


Effective treatment of hypothyroidism is a major concern since this disorder affects so many young people and can lead to years of disabling symptoms. As I have expressed in another article on this website, “Hypothyroid? Will You Benefit From T3 (Cytomel)?”, I am an advocate of combining t4 and t3 to treat hypothyroidism particularly for the patient who has failed to achieve a return to normal function when their hypothyroidism is treated with conventional t4 alone. For this reason I looked forward to reviewing a recent study of this controversial subject in the prestigious Journal of the American Medical Association, Combined levothyroxine (t4) plus liothyronine (t3) compared with levothyroxine alone in primary hypothyroidism: a randomized controlled trial by PW Clyde, and colleagues. Unfortunately I was greatly disappointed in this most recent research.

The study was conducted in 46 hypothyroid patients who were divided randomly into two groups. One group continued to receive their standard dose of t4 and the other group was switched to a lower dose of t4 and had a small dose of t3 added to it. The result was that there were no physical or psychological differences between these two groups of subjects after four months. The conclusion was ‘Compared with levothyroxine alone, treatment of primary hypothyroidism with combination levothyroxine plus liothyronine demonstrated no beneficial changes…’.

What went wrong with the good intentions of these researchers? Dividing their group of hypothyroid patients randomly without regard to their pre-study response to conventional treatment with t4 makes it almost impossible to identify those who are likely to benefit most from intervention with t3. The target group should have been those who are doing poorly on t4 alone. The number of patients looked at, 46, is a tiny number, making it unlikely that any differences in treatment would be seen. It is easy to miss seeing any difference in treatments when you look at a small number of individuals. Finally, the amount of t3 (7.5 micrograms) administered is barely sufficient to produce a clinical effect, further reducing the chance of observing any benefit.

I believe the authors of this study asked the wrong question and used techniques which made it almost impossible to see the differences in treatment outcomes that they were searching for. The negative results of this study will probably inhibit the use of t3 in medical practices throughout the country for years to come. It is little wonder that there are so many people who are unhappy with the treatment they receive for hypothyroidism. Perhaps my comments here will be helpful for those who agree that despite these latest research findings, t3 added to t4 can still be considered a valuable alternative when treating hypothyroidism.

The opinions expressed in this article are not meant to serve as medical advice. Always consult with your health care professional before starting any new course of therapy.

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