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ORLANDO -- Patients with hypothyroidism who were on long-term Synthroid (thyroxine T4) treatment despite not responding well saw improved outcomes after switching to combination triiodothyronine (T3) and T4 therapy, according to a researcher here.
According to a chart review with an average follow-up of 25 months, among 82 patients who had taken Synthroid for at least 5 years, 69 were switched to the combination therapy Armour, and 13 were switched to T3 (Cytomel) and levothyroxine.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
The vast majority (94.2%) of the patients on Armour reported an improvement in symptoms and all 13 patients in the other group improved, reported Anam Tariq, MD, at Pinnacle Health Endocrinology in Pennsylvania, at the American Association of Clinical Endocrinologists (AACE) annual meeting.
Also, thyroid-stimulating hormone levels were normal in 88% of patients on Armour and 59% of patients on Cytomel (P<0.05), while 65% of patients on Armour had normalized T3 levels versus 53% of those on Cytomel. Only 8% of patients in the study had levels in hyperthyroid ranges, Tariq stated.
"While these patients had been on Synthroid, and while they had increased their doses, they still felt like they were miserable," said Tariq in an interview with 51˶. "But with combination therapy, they did see an improvement in terms of how they were feeling: they were able to do more activities, they were able to be more active with their grandchildren, with other people, do their normal things around the house, and they felt like their mood was stable, and reported just feeling happier."
Tariq administered a SF-20 questionnaire to determine how patients said they felt after combination therapy. Nearly 93% stated that their health was better, and patient satisfaction and quality of life was improved with combination therapy without causing "significant hyperthyroidism."
Trials of combination T3 and T4 therapy have not been encouraging, Tariq explained, but many of them didn't exclude patients who had normal T3 levels, or who were fatigued for other reasons. In addition, the ratio of T3 to T4 in the treatment varied significantly by study, and many of the studies lasted fewer than 6 months. T4 monotherapy is the treatment recommended by AACE and the Endocrine Society, according to the author.
Patients who had unsuccessful T4 monotherapy were put on either Armour or Cytomel and levothyroxine; those who still didn't improve then switched groups if they didn't develop arrhythmia or hyperthyroidism.
Tariq added that she and her colleagues hope to do a prospective study looking at the effectiveness and safety of long-term combination therapy for patients with hypothyroidism.
Disclosures
Tariq disclosed no relevant relationships with industry.
Primary Source
American Association of Clinical Endocrinologists
Tariq A "Combination of T3 and T4 therapy for improving hypothyroidism and overall quality of life" AACE 2016; Abstract 1153.