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Combinination Levothyroxine/Liothyronine Shows No Obvious Benefit Over Levothyroxine Alone in Patients With Primary Hypothyroidism
Journal of the American Medical Association (JAMA)
12/11/2003
By Joene Hendry
Patients who are treated with a combination of levothyroxine plus liothyronine for primary hypothyroidism gained no apparent benefit compared with patients treated with levothyroxine monotherapy, say researchers.
Patrick W. Clyde, MD, National Naval Medical Center, Bethesda, Maryland, United States, and colleagues evaluated the combined and monotherapy regimens in 46 patients, aged between 24 and 65 years, treated with levothyroxine for primary hypothyroidism for at least 6 months.
The 23 patients randomised to the combined therapy group reduced their usual levothyroxine dose by 50 µ per day and substituted twice daily 7.5 µ liothyronine. The 23 patients in the monotherapy group also reduced their daily levothyroxine by 50 µ per day, but to mimic the combined therapy regimen and maintain the blinded nature of the study, this group took 25 µ levothyroxine twice daily.
Over 4 months of therapy, 1 patient in the monotherapy group dropped out of the study due to lack of time for follow-up testing while a second patient dropped out of the combined therapy group with complaints of tremulousness, fatigue, and poor workplace performance. No other adverse events occurred among the remaining 44 patients, whose serum thyrotropin levels, body weight, and serum lipid levels remained similar to baseline.
Both groups had improved scores on hypothyroid-specific health-related quality-of-life questionnaires over baseline: 23% in the monotherapy group and 12% in the combined therapy group, but the researchers noted these changes were statistically similar.
In 13 neuropsychological tests the groups had similar results in all outcomes except for a Grooved Peg Board test in which the combined therapy group demonstrated a declined performance from baseline.
The authors note that new treatment guidelines for primary hypothyroidism recommend using only levothyroxine. "This study supports these guidelines, they conclude, "by providing sound evidence that levothyroxine alone continues to be the most appropriate therapy for patients with primary hypothyroidism."
JAMA 2003;290:2952-2958.
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