Effective treatment of hypothyroidism: A Synthesis of Findings from 18 Studies

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Original Abstract of the Article

Major research findings

Levothyroxine (LT4) monotherapy has been the standard treatment for hypothyroidism. However, there is growing interest in combination therapy with LT4 and liothyronine (LT3), as some patients may not experience full symptom relief with LT4 alone, and LT3 may help achieve a more natural hormone balance. 12 suggests that the timing of LT4 administration can impact thyroid function and lipid metabolism. 7 examined the effect of combined thyroxine and triiodothyronine therapy on psychiatric symptoms and found no significant differences compared to thyroxine alone. However, 4 suggests that using slow-release LT3 in combination with LT4 may lead to improved blood hormone levels and potentially be more effective than LT4 alone. 15 found no definitive evidence that LT4 supplementation improves pregnancy outcomes in euthyroid women with thyroid autoimmunity, suggesting the need for further research.

Symptoms of hypothyroidism vary widely, making clinical diagnosis challenging. 6 reviewed various tools used to measure symptoms, health status, and quality of life in hypothyroidism, highlighting the need for appropriate instruments in addition to biochemical tests.

Beyond medication, lifestyle modifications and support for mental and physical well-being are crucial for hypothyroidism management. 9 proposes a pilot study to investigate the effectiveness of a biopsychosocial approach to hypothyroidism, highlighting the growing support for this approach within the chiropractic profession.

New therapeutic strategies are being explored beyond hormone replacement therapy, including tissue engineering and regenerative medicine. 17 reviews systematic research on the development of functional thyroid tissue through tissue engineering, offering hope for future treatment options.

Treatment summary

Levothyroxine (LT4) monotherapy is the standard treatment for hypothyroidism. 12 suggests that the timing of LT4 administration may affect treatment outcomes. If LT4 monotherapy does not provide sufficient symptom relief or a more natural hormone balance is desired, combination therapy with LT4 and liothyronine (LT3) may be considered. 4 suggests that using slow-release LT3 in combination with LT4 may lead to improved blood hormone levels and potentially be more effective than LT4 alone. However, further research is needed to confirm the efficacy of LT4-LT3 combination therapy. 7 found no significant differences in psychiatric symptom improvement with LT4-LT3 combination therapy compared to LT4 alone. 15 found no definitive evidence that LT4 supplementation improves pregnancy outcomes in euthyroid women with thyroid autoimmunity, suggesting the need for further research.

Benefits and Risks

Benefit summary

LT4 monotherapy is generally well-tolerated and can effectively improve symptoms and restore hormone balance in hypothyroidism. 12 suggests that the timing of LT4 administration can impact thyroid function and lipid metabolism. 2 found that short-term LT4 administration did not lead to bone density reduction in postmenopausal women with subclinical hypothyroidism. LT4-LT3 combination therapy may offer additional benefits for those who do not respond fully to LT4 monotherapy. 4 suggests that using slow-release LT3 in combination with LT4 may lead to improved blood hormone levels and potentially be more effective than LT4 alone. However, further research is needed to confirm the efficacy of LT4-LT3 combination therapy. 7 found no significant differences in psychiatric symptom improvement with LT4-LT3 combination therapy compared to LT4 alone.

Risk summary

LT4 monotherapy typically has few side effects, but may cause palpitations, insomnia, or sweating. LT4-LT3 combination therapy may carry a higher risk of side effects compared to LT4 alone. 7 found no significant differences in psychiatric symptom improvement with LT4-LT3 combination therapy compared to LT4 alone. 15 found no definitive evidence that LT4 supplementation improves pregnancy outcomes in euthyroid women with thyroid autoimmunity, suggesting the need for further research.

Research comparison

Research similarities

Most studies confirm the effectiveness of LT4 monotherapy for hypothyroidism. There is a general consensus that further research is necessary to understand the effectiveness of LT4-LT3 combination therapy.

Research differences

The effectiveness of LT4-LT3 combination therapy varies across studies. 4 suggests that using slow-release LT3 in combination with LT4 may lead to improved blood hormone levels and potentially be more effective than LT4 alone. However, 7 found no significant differences in psychiatric symptom improvement with LT4-LT3 combination therapy compared to LT4 alone. 15 found no definitive evidence that LT4 supplementation improves pregnancy outcomes in euthyroid women with thyroid autoimmunity, suggesting the need for further research.

Consistency and contradictions in results

The inconsistent findings regarding the efficacy of LT4-LT3 combination therapy make it difficult to draw definitive conclusions. Further research is needed. 7 found no significant differences in psychiatric symptom improvement with LT4-LT3 combination therapy compared to LT4 alone. However, 4 suggests that using slow-release LT3 in combination with LT4 may lead to improved blood hormone levels and potentially be more effective than LT4 alone. 15 found no definitive evidence that LT4 supplementation improves pregnancy outcomes in euthyroid women with thyroid autoimmunity, suggesting the need for further research.

Practical implications

Hypothyroidism treatment should be individualized based on individual symptoms and causes. Consult with a doctor for proper diagnosis and management. 5 found that replacing a portion of LT4 with LT3 in a 1:5 ratio did not improve fatigue, symptoms of depression, or working memory. 8 highlights the need for research to determine optimal initial doses of levothyroxine in congenital hypothyroidism.

Limitations of current research

The number of studies on hypothyroidism treatment is limited, making it challenging to generalize the findings. Research designs and evaluation methods vary across studies, making comparisons difficult.

Future research directions

Further research is needed to thoroughly investigate the efficacy and safety of LT4-LT3 combination therapy. Development of personalized treatment strategies tailored to individual patient symptoms and conditions is also crucial.

Conclusion

Levothyroxine (LT4) monotherapy is the standard treatment for hypothyroidism. LT4-LT3 combination therapy may be considered if LT4 monotherapy is insufficient, but further research is needed. Treatment should be personalized based on individual factors. Consult your doctor for diagnosis and management. 5 found that replacing a portion of LT4 with LT3 in a 1:5 ratio did not improve fatigue, symptoms of depression, or working memory. 8 highlights the need for research to determine optimal initial doses of levothyroxine in congenital hypothyroidism. Further research is expected to lead to the development of more effective and safe treatment options.

Treatment list

Levothyroxine (LT4) monotherapy LT4 and liothyronine (LT3) combination therapy Slow-release LT3

Literature analysis of 18 papers
Positive Content
14
Neutral Content
4
Negative Content
0
Article Type
9
3
6
4
17
1.

Treatment of hyperthyroidism with radioiodine: adjunctive therapy with antithyroid drugs reconsidered.

Author: VelkeniersB, CytrynR, VanhaelstL, JonckheerM H

Reduced hypothyroidism
Increased recurrence
Lower remission rates

A study of 206 patients treated with radioactive iodine for hyperthyroidism found that those who received antithyroid drugs after treatment had a lower incidence of hypothyroidism but a higher incidence of early relapse or persistent hyperthyroidism.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

2.

Bone density is not reduced during the short-term administration of levothyroxine to postmenopausal women with subclinical hypothyroidism: a randomized, prospective study.

Author: RossD S

Improved hypothyroid symptoms
Reduced bone density

Two randomized trials reported that hypothyroid symptoms improved following thyroid hormone replacement therapy for subclinical hypothyroidism. However, three studies have shown that initial treatment with levothyroxine for overt hypothyroidism can lead to short-term reductions in bone density.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, U.S. Gov't, P.H.S.Research funding provided by the Public Health Service (PHS).

Language : English

3.

Initial treatment dose of L-thyroxine in congenital hypothyroidism.

Author: SelvaKarin A, MandelScott H, RienLeanne, SesserDavid, MiyahiraRichard, SkeelsMichael, NelsonJerald C, LafranchiStephen H

CH treatment

The study aims to determine the optimal initial treatment dose of L-thyroxine in congenital hypothyroidism (CH) and to re-evaluate the target range for thyroxine (T(4)) and free T(4) concentrations.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

4.

Thyroxine plus low-dose, slow-release triiodothyronine replacement in hypothyroidism: proof of principle.

Author: HennemannG, DocterR, VisserT J, PostemaP T, KrenningE P

Hypothyroidism treatment

This study investigated the use of a combination of thyroxine (T4) and triiodothyronine (T3) to treat hypothyroidism, comparing it to treatment with T4 alone. The study found that using a slow-release form of T3 alongside T4 resulted in more balanced levels of thyroid hormones in the blood and a more normalized TSH level compared to T4 alone. The study suggests that this combination treatment may be more effective than T4 alone, particularly considering the potential for improved tissue-level thyroid hormone balance.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

5.

Substitution of liothyronine at a 1:5 ratio for a portion of levothyroxine: effect on fatigue, symptoms of depression, and working memory versus treatment with levothyroxine alone.

Author: RodriguezTom, LavisVictor R, MeiningerJanet C, KapadiaAsha S, StaffordLinda F

Substituting liothyronine (LT3) for a portion of levothyroxine (LT4) did not improve fatigue, mood, cognition, or other symptoms in patients with primary hypothyroidism.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, U.S. Gov't, P.H.S.Research funding provided by the Public Health Service (PHS).

Language : English

6.

Instruments used in measuring symptoms, health status and quality of life in hypothyroidism: a systematic qualitative review.

Author: RazviSalman, McMillanCarolyn V, WeaverJolanta U

Assess treatment response
Quantify disease severity

This study highlights the importance of using appropriate symptom, health status, and quality of life instruments in addition to biochemical tests for diagnosing and monitoring hypothyroidism, given the varied and nonspecific nature of its symptoms.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

7.

Treatment of clinical hypothyroidism with thyroxine and triiodothyronine: a literature review and metaanalysis.

Author: JoffeRussell T, BrimacombeMichael, LevittAnthony J, Stagnaro-GreenAlex

Hypothyroidism treatment
Limited study design

Combined thyroxine-plus-triiodothyronine treatment for hypothyroidism has not been shown to be more effective than thyroxine alone in improving psychiatric symptoms.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

8.

High versus low dose of initial thyroid hormone replacement for congenital hypothyroidism.

Author: NgSze May, AnandDhullipala, WeindlingAlan M

Congenital hypothyroidism (CHT) affects about 1 in 3,000 to 4,000 babies and can cause learning disabilities if not treated early. While prompt treatment with thyroid hormone is crucial, the best starting dose for optimal development is unclear. Further research is needed to determine whether higher or lower doses are better for CHT.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

10.

A Systematic Review of Clinical Practice Guidelines' Recommendations on Levothyroxine Therapy Alone versus Combination Therapy (LT4 plus LT3) for Hypothyroidism.

Author: KrautEyal, FarahaniPendar

LT4/LT3 for hypothyroidism

This systematic review examines clinical practice guidelines from around the world to identify consensus regarding the use of combination therapy (levothyroxine and liothyronine) for treating hypothyroidism. Combination therapy remains controversial, and the study aims to provide clarity on current recommendations.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

11.

Quality of life, clinical outcomes and safety of early prophylactic levothyroxine administration in patients with Graves' hyperthyroidism undergoing radioiodine therapy: a randomized controlled study.

Author: TaïebDavid, BournaudClaire, EberleMarie-Claude, CatargiBogdan, SchvartzClaire, CavarecMarie-Béatrice, FaugeronIsabelle, ToubertMarie-Elisabeth, BenisvyDanielle, ArchangeCendrine, MundlerOlivier, CaronPhilippe, AbdullahAhmad Esmaeel, BaumstarckKarine

Graves' disease treatment
Hypothyroidism risk

Radioactive iodine is a common treatment for Graves' disease. However, it can sometimes lead to long-term low thyroid function (hypothyroidism), causing symptoms that affect quality of life. Starting medication for low thyroid (levothyroxine, LT4) early after treatment may help prevent this problem.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

12.

Effect of timing of levothyroxine administration on the treatment of hypothyroidism: a three-period crossover randomized study.

Author: SkelinMarko, LucijanićTomo, Liberati-ČizmekAna-Marija, KlobučarSanja Majanović, LucijanićMarko, JakupovićLejsa, BakulaMiro, LončarJelena Vučak, MarušićSrečko, MatićTomas, RomićŽeljko, DumićJerka, RahelićDario

The timing of levothyroxine (LT4) administration may affect thyroid function status and lipid profile. This study investigates the effects of different LT4 administration timings.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

13.

Combined therapy with levothyroxine and liothyronine for hypothyroidism.

Author: FischmanAlexandra, DomínguezJosé Miguel

Hypothyroidism treatment
Liothyronine and levothyroxine

Hypothyroidism is usually treated with a single medication called levothyroxine. However, some people still have symptoms despite taking this medication. A combination of levothyroxine and liothyronine may be more beneficial for these patients.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.

Language : Spanish

14.

Thyroxine replacement for subfertile women with euthyroid autoimmune thyroid disease or subclinical hypothyroidism.

Author: AkhtarM Ahsan, AgrawalRina, BrownJulie, SajjadYasmin, CraciunasLaurentiu

Subfertility improvement
Thyroxine treatment

Thyroxine may be useful for subfertile women with subclinical hypothyroidism or autoimmune thyroid disease (ATD) to improve pregnancy outcomes during assisted reproduction.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

15.

A Meta-Analysis of Pregnancy Outcomes With Levothyroxine Treatment in Euthyroid Women With Thyroid Autoimmunity.

Author: SunXiaodong, HouNingning, WangHongsheng, MaLin, SunJinhong, LiuYongping

Pregnancy outcomes
Thyroid autoimmunity

Levothyroxine (LT4) supplementation in euthyroid women with thyroid autoimmunity (TAI) did not improve pregnancy outcomes, but individualized dosages and early intervention may reduce miscarriage and preterm birth rates.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

16.

Comparative Effectiveness of Levothyroxine, Desiccated Thyroid Extract, and Levothyroxine+Liothyronine in Hypothyroidism.

Author: ShakirMohamed K M, BrooksDaniel I, McAninchElizabeth A, FonsecaTatiana L, MaiVinh Q, BiancoAntonio C, HoangThanh D

Hypothyroid treatment

This study compared different thyroid hormone replacement therapies: levothyroxine (LT4) alone, LT4 combined with liothyronine (LT3), and desiccated thyroid extract (DTE). The study investigated the effectiveness of these treatments for all hypothyroid patients as well as those experiencing the most symptoms.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, U.S. Gov't, Non-P.H.S.Research funding provided by US government agencies other than the Public Health Service.

Language : English

18.

Achievements in Hypothyroidism Treatment with Herbal Medicine: A Systematic Review of Randomized Controlled Trials.

Author: JavidiNajmeh, KhorasaniZahra Mazloum, SalariRoshanak, NiroumandShabnam, YousefiMahdi

Hypothyroidism treatment

Hypothyroidism is a common condition that can cause health problems, especially in older adults. While medications are used to treat hypothyroidism, they can have side effects. Herbal remedies are being explored as a potential treatment for hypothyroidism that can regulate thyroid hormones and reduce side effects.

Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

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