Can you summarize what the current evidence, expert opinion, and clinical experience has taught us, and how it should guide us, in terms of identifying persons with hypothyroidism who should be considered for DTE-based hormone replacement therapy?
So the hypothyroid population need various treatment options. This is not a one size fits all approach to thyroid care. Not every patient metabolizes certain thyroid medicines the same. We don't understand all of the nuances behind that, but we do understand that there are real reasons that people don't take T4 only monotherapy and convert well to T3. And in summary, that would be things like excess adipose tissue, sarcopenia, medications that impair T4 to T3 conversion, and inflammation. Those are the major reasons why people don't take T4 and convert to T3. So, um, when we're thinking about all of the different options for patients, and we really want to as providers nail that right off the get-go. If we have patients who are healthy, otherwise healthy, they have good muscle mass, they're not obese, we might start T4 monotherapy. That's what the guidelines say to do. But if the patient in front of us is morbidly obese, if they have multiple comorbidities, if they have severe arthritis and inflammation and they're in pain all the time, Then that may be a patient who would greatly benefit from T4-T3 combination therapy or DTE products, and that should be a conversation that we have with those patients. And again, T4-T3 Um, by themselves are great. You just need to know how to dose them correctly. And sometimes liothyronine products can be very, um, jarring to a patient who is sensitive to T3 medication because of how quickly it peaks in the bloodstream. DTE products overcome that T4 to T3 conversion issue if it's completely cut off. Um, so because DTE products have that 4:1 ratio of T4 to T3, that overcomes what is needed daily in the body for T4 and T3 and doesn't rely on DONase conversion. And those are patients who really would potentially benefit greatly from having this as a treatment option.
