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 causing the presence of 10-15% of patients with hypothyroidism who are dissatisfied with levothyroxine monotherapy? What is the role of T3 as a causative factor? And what are the implications for combination therapy and/or DTE?
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How does the peripheral metabolism—the conversion or compromised conversion of T4 to T3—affect a patient’s response to T4 monotherapy? How does that set the stage for combination T4 plus T3 therapy in appropriately selected patients?
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The recognition that LT4 monotherapy is inadequate for producing symptomatic improvement in many patients has led to the formation of an international working group focused on identifying such patients. Can you share your experience with this group?
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Can you summarize the current treatment challenges for hypothyroidism as encountered by a broad spectrum of clinicians, including primary care, internal medicine, endocrine, women’s health, and geriatric specialists?
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What practical advice would you give to physicians who are not familiar with the specifics of how to initiate and/or monitor therapy with DTE? Are conversion tables available? Is there data to suggest which approach is better—DTE or T4/T3 (Cytomel)?
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From a front lines clinical perspective, what does the treatment roadmap for combination T3/T4 therapy look like? What approach to combination therapy do you recommend for the primary care, internal medicine, and/or women’s health specialist?
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What laboratory and/or clinical features, especially persistent symptoms, suggest the need for combination therapy—including with a DTE—to optimize management? What have trials evaluating patient preferences suggested about combination therapy?
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Once you decide on combination therapy, what are the practical strategies—specifically, approved drug formulations, whether it be synthetic T3 (Cytomel) or DTE—that clinicians should consider at the front lines of care for hypothyroidism?
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Can you walk us through the typical presentation of a patient with hypothyroidism and what the guideline-adherent approach is to laboratory evaluation, clinical decision tree and initiation of therapy?