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What is the alternative to using monotherapy with levothyroxine? And what role has dessicated thyroid extract (DTE) played historically in treating hypothyroidism, and what have we learned from this experience?

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What is the alternative to using monotherapy with levothyroxine? And what role has dessicated thyroid extract (DTE) played historically in treating hypothyroidism, and what have we learned from this experience?

Created by

CMEducation Resources IQ&A Thyroid Hormone Replacement Medical Intelligence Zone

Presenter

Antonio Bianco, MD, PhD

Antonio Bianco, MD, PhD

Professor of Medicine Department of Medicine Division of Endocrinology University of Chicago Chicago, Illinois

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Can you review current ATA-consistent guidelines for specific thyroid replacement formulations initially recommended in newly diagnosed persons with hypothyroidism? Why is T4 (levothyroxine) alone usually recommended as opposed to combination T4/T3?

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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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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?

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?

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?

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?

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?

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?

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?

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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?

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?

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?

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?