symptoms despite being biochemically euthyroid [ 1 ]. European Thyroid Association (ETA) guidelines [ 2 ] from 2012 suggest that L-T 4 /liothyronine (L-T 3 ) combination therapy could be considered as an experimental approach for compliant patients with
Bjarke Borregaard Medici, Jeppe Lerche la Cour, Luba Freja Michaelsson, Jens Oscar Faber, and Birte Nygaard
Wilmar M. Wiersinga, Leonidas Duntas, Valentin Fadeyev, Birte Nygaard, and Mark P.J. Vanderpump
pharmaceutical companies in strengths ranging from 25 to 200 µg. Liothyronine (L-T3) tablets are commercially produced (brand names, e.g. Cytomel in strengths of 5 µg, 12.5 µg and 25 µg; Thybon in strengths of 20 µg and 100 µg); their availability varies per
Antonio C. Bianco and Sabina Casula
Brain T 3 Be Restored by Treatment with Combined Levothyroxine and Liothyronine Therapy? There is circumstantial evidence supporting the paradigm that a variability/defect in thyroid hormone transport and/or metabolism could lead to insufficient T 3
Luba Freja Michaelsson, Jeppe Lerche la Cour, Bjarke Borregaard Medici, Torquil Watt, Jens Faber, and Birte Nygaard
-being to be restored [ 1 ]. An alternative treatment with L-T 4 /liothyronine (L-T 3 ) combination therapy remains controversial, but is nonetheless often requested by patients. The European Thyroid Association concluded in its 2012 guidelines that a small
Luba Freja Michaelsson, Bjarke Borregaard Medici, Jeppe Lerche la Cour, Christian Selmer, Michael Røder, Hans Perrild, Nils Knudsen, Jens Faber, and Birte Nygaard
enzymes converting thyroxine (T 4 ) to T 3 , qualifying these patients for combination therapy [ 3 ]. T 4 /T 3 combination therapy can be given as combination of L-T 4 /liothyronine (L-T 3 ) or as desiccated thyroid. The therapy is controversial: T 3
Jeppe Lerche la Cour, Line Tang Møllehave, Bjarke Røssner Medici, Christian Zinck Jensen, Anne Ahrendt Bjerregaard, and Birte Nygaard
increased, and it has been suggested that some hypothyroid patients could improve their quality of life if treated with liothyronine (L-T3) or desiccated thyroid extract (DTE). However, L-T3 and DTE therapy is still controversial among endocrinologists and
Roberto Fiore, Stefano La Rosa, Silvia Uccella, Deborah Marchiori, and Peter A Kopp
requirement for substitution with very high doses of levothyroxine to overcome the massive inactivation of T4, or, alternatively, the need for substitution with liothyronine (LT3). Consumptive hypothyroidism has been mainly reported in highly vascularized
Birte Nygaard, Lars Bastholt, Finn Noe Bennedbæk, Tobias Wirenfeldt Klausen, and Jens Bentzen
studies have been made on patients with an L-T 4 THW of 3-6 weeks or a mixture of L-T 4 THW and liothyronine (L-T 3 ) THW for 10-14 days. The advantage of using L-T 3 THW is that the half-life is shorter and thereby it is possible to shorten the
Petros Perros
References 1 Wiersinga WM, Duntas L, Fadeyev V, Nygaard B, Vanderpump MPJ: 2012 ETA Guidelines: the use of L-T4 + L-T3 in the treatment of hypothyroidism. Eur Thyroid J 2012;1:55–71. 2 Bunevicius R, Kazanavicius G, Zalinkevicius R
Allan Carlé, Jens Faber, Rudi Steffensen, Peter Laurberg, and Birte Nygaard
with combined levo-triiodothyronine (L-T3) + L-T4 preparations [ 6 ]. In the 2012 European Thyroid Association guidelines for the use of L-T4 and L-T3 in the treatment of hypothyroidism, Wiersinga et al. [ 6 ] reviewed 5 cross-over studies [ 7 - 11
