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
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Can you give clinicians a sense of how many people treated for hypothyroidism with T4 monotherapy fall into a “less than optimal outcome” category and should be considered for combination approaches, including those that might include DTE?
What percentage of patients who, for symptomatic reasons, have been switched from LT4 monotherapy to DTE, do you find actually improve on DTE, and what do they report?
When using LT4 monotherapy, is monitoring of TSH sufficient to guide therapy? Can you elaborate on this?
There is a subset of patients who don’t respond to or are dissatisfied with levothyroxine (T4) monotherapy. What percentage don’t respond to conventional therapy? Why is combination therapy with T3/T4 considered appropriate for this group?
Under what circumstances would a clinician consider deploying combination T4/T3 therapy, whether adding on synthetic T3 to T4 or considering dessicated thyroid extract (DTE)? How do you identify patients who are appropriate for combination therapy?
How would you summarize your experience with hypothyroidism, in particular, your perspective on the current role of combination therapy with DTE?
Can you discuss the consensus report on identifying a subset of patients with hypothyroidism who fsaol to achieve optimal symptomatic resolution with LT4 monotherapy; and, therefore, should be considered for combination T4/T3 combination therapy?
Once you commit a person with hypothyroidism to combination therapy with T4/T3, how do you follow the patient? What have you observed as far as improvements in patient status and/or their perceptions about the effects of combination T4/T3 therapy?
What is your approach to the patient who has a TSH of 2.5—well within the normal range—but the patient still has symptoms? Is there a rationale for bringing the TSH down to, let’s say, 1. 0 or 0.7, that is, to a lower level within the normal range?