The Role, Rationale, Evidence and Practical Application of
Combination Therapy with DTE in Selected Patients with Hypothyroidism
A Year 2021 Hypothyroidism Update for the Endocrinology, Primary Care, Internal Medicine, and Thyroid Specialist
A Year 2021 Hypothyroidism Update for the Endocrinology, Primary Care, Internal Medicine, and Thyroid Specialist
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What is your initial, ATA guidelines-sanctioned approach to therapy for hypothyroidism and when might this initial strategy require modification? How focused should we be on “squaring the numbers”—TSH and T4 and/or T3—as a benchmark for success?
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From an overview and call-to-action perspective, can you discuss the importance of screening, diagnosis and assessment of hypothyroidism? What is the unique metabolic role and impact of T3 on target organs, especially the cardiovascular system and CNS?
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Although guidelines indicate that normalization of TSH and thyroid hormone levels is an important goal confirming successful treatment with hormone replacement, is this the optimal approach and/or the singular criterion clinicians should focus on?
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Is it preferable to use DTE as a stand-alone combination therapy to substitute for LT4, or can/should it be used to supplement LT4 monotherapy? And what is the safety profile of DTE? And what is the monitoring strategy for combination therapy?
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Once we decide to treat a patient with laboratory findings and a clinical presentation compatible with hypothyroidism, how do we initiate treatment with synthetic LT4? How do we monitor with respect to LT4, T3, TSH, and their global health?
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What is your approach to persons who have a TSH level between 4.5 and 10? Do they all get treated, or are there other stratification criteria—i.e., the presence of antithyroid antibodies—you use to determine the need for thyroid hormone therapy?
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Once you begin thyroid hormone replacement therapy, how is that patient followed clinically to ensure treatment success? What are the recommended starting doses? How do you titrate the dose over time?
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Can you summarize the current role of DTE in managing persons with hypothyroidism, and the approach to identifying the 10%-20% of persons on LT4 monotherapy who, because of symptomatic shortfalls, may be appropriate for combination therapy?
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Once you decide to treat, in order to address the full treatment “outcome” equation—that is, achieving both laboratory (TSH, T4) targets and symptomatic/quality-of-life goals—how do you construct your therapeutic regimen?