Combination Hormone Therapy Does Not Benefit Hypothyroid Patients, Says New Study
Friday October 3, 2003
Combining two hormone therapies to treat the psychological affects of hypothyroidism may not be more effective than using a single therapy, according to new research articles published this month in the Journal of Clinical Endocrinology & Metabolism (JCEM). Two new studies and an editorial question whether a combination of thyroxine (T4) and T3 is superior to T4 alone for the treatment of patients with hypothyroidism...
The new findings will be of great importance to the five to 10 percent of Americans who suffer from hypothyroidism, which occurs when the thyroid gland does not produce enough thyroid hormone. Symptoms of hypothyroidism can include fatigue, weight gain, thinned hair, decreased cardiac function, menstrual irregularities, sluggishness, dry skin, and constipation.
One study, which was led by researchers from McMaster University in Ontario, Canada, specifically examined whether a combination of T4 and T3 therapy improved mood and sense of well being in hypothyroid patients who also suffered from depressive symptoms. In the prospective, double-blinded, randomized controlled trial, forty patients were randomized to receive either T4 therapy alone or a combination of T3 and T4 therapy. The results showed that when compared with T4 alone, the combination therapy did not improve either mood or personal sense of well being in the patients. The 15-week study was longer than any previously published studies on this subject.
"Data do not support the routine use of T3 in addition to T4 to maintain euthyroidism in hypothyroid patients who are on stable doses of levothyroxine hormone, but who complain of depressive symptoms. Until a future large, multicenter, blinded, randomized, controlled trial proves otherwise, there is insufficient evidence to support changing the current approach of routinely using T4 alone to maintain euthyroidism in hypothyroid individuals," explained Dr. Anna Sawka, the first author on the study.
A second study published this month in JCEM also compared a combination T4 and T3 therapy with T4. In the second study, which was a double-blind, random order, crossover trial, researchers from Sir Charles Gairdner Hospital in Perth, Australia compared the impact of the two treatments on quality of life, cognitive function and subjective satisfaction in 110 hypothyroid patients. In this study, approximately one-half of the subjects received T4 therapy for 10 weeks and then T4 and T3 therapy for 10 weeks. The other half of the subjects received the combination therapy first.
Once again, the researchers found no significant benefits for combination therapy compared to T4 alone. However, they did find that anxiety and nausea were significantly worse for patients on the combined therapy.
"At the conclusion of our trial, we found no benefit of combining T4 and T3 therapy on quality of life, hypothyroid symptoms, cognitive function, subjective satisfaction with therapy or treatment preference," notes Dr. John P. Walsh, the senior author on the study. "Furthermore, we could not identify a specific subgroup of patients who benefited from the combined therapy. Based on these findings, we believe that T4 alone should remain the standard treatment for hypothyroidism."
In addition to the two new studies, the October issue of JCEM also includes an editorial by Drs. Michael Kaplan, David Sarne and Arthur Schneider, which discusses the use of T4 and T3 therapy to treat hypothyroid patients. In the editorial, the authors discuss the two new studies as well as previous research that examined T4 and T3 therapy. The authors write that based on past and current research, "evidence is fading that adding T3 to T4 is beneficial in the long-term treatment of hypothyroid patients with autoimmune thyroiditis."
JCEM is one of four journals published by The Endocrine Society. Founded in 1916, The Endocrine Society is the world's oldest, largest, and most active organization devoted to research on hormones, and the clinical practice of endocrinology. Endocrinologists are specially trained doctors who diagnose, treat and conduct basic and clinical research on complex hormonal disorders such as diabetes, thyroid disease, osteoporosis, obesity, hypertension, cholesterol and reproductive disorders. Today, The Endocrine Society's membership consists of over 11,000 scientists, physicians, educators, nurses and students, in more than 80 countries. Together, these members represent all basic, applied, and clinical interests in endocrinology. The Endocrine Society is based in Chevy Chase, Maryland. To learn more about the Society, and the field of endocrinology, visit the Society's web site at www.endo-society.org
Source: Endocrine Society Press Release: Friday October 3, 12:50 pm ET
The new findings will be of great importance to the five to 10 percent of Americans who suffer from hypothyroidism, which occurs when the thyroid gland does not produce enough thyroid hormone. Symptoms of hypothyroidism can include fatigue, weight gain, thinned hair, decreased cardiac function, menstrual irregularities, sluggishness, dry skin, and constipation.
One study, which was led by researchers from McMaster University in Ontario, Canada, specifically examined whether a combination of T4 and T3 therapy improved mood and sense of well being in hypothyroid patients who also suffered from depressive symptoms. In the prospective, double-blinded, randomized controlled trial, forty patients were randomized to receive either T4 therapy alone or a combination of T3 and T4 therapy. The results showed that when compared with T4 alone, the combination therapy did not improve either mood or personal sense of well being in the patients. The 15-week study was longer than any previously published studies on this subject.
"Data do not support the routine use of T3 in addition to T4 to maintain euthyroidism in hypothyroid patients who are on stable doses of levothyroxine hormone, but who complain of depressive symptoms. Until a future large, multicenter, blinded, randomized, controlled trial proves otherwise, there is insufficient evidence to support changing the current approach of routinely using T4 alone to maintain euthyroidism in hypothyroid individuals," explained Dr. Anna Sawka, the first author on the study.
A second study published this month in JCEM also compared a combination T4 and T3 therapy with T4. In the second study, which was a double-blind, random order, crossover trial, researchers from Sir Charles Gairdner Hospital in Perth, Australia compared the impact of the two treatments on quality of life, cognitive function and subjective satisfaction in 110 hypothyroid patients. In this study, approximately one-half of the subjects received T4 therapy for 10 weeks and then T4 and T3 therapy for 10 weeks. The other half of the subjects received the combination therapy first.
Once again, the researchers found no significant benefits for combination therapy compared to T4 alone. However, they did find that anxiety and nausea were significantly worse for patients on the combined therapy.
"At the conclusion of our trial, we found no benefit of combining T4 and T3 therapy on quality of life, hypothyroid symptoms, cognitive function, subjective satisfaction with therapy or treatment preference," notes Dr. John P. Walsh, the senior author on the study. "Furthermore, we could not identify a specific subgroup of patients who benefited from the combined therapy. Based on these findings, we believe that T4 alone should remain the standard treatment for hypothyroidism."
In addition to the two new studies, the October issue of JCEM also includes an editorial by Drs. Michael Kaplan, David Sarne and Arthur Schneider, which discusses the use of T4 and T3 therapy to treat hypothyroid patients. In the editorial, the authors discuss the two new studies as well as previous research that examined T4 and T3 therapy. The authors write that based on past and current research, "evidence is fading that adding T3 to T4 is beneficial in the long-term treatment of hypothyroid patients with autoimmune thyroiditis."
JCEM is one of four journals published by The Endocrine Society. Founded in 1916, The Endocrine Society is the world's oldest, largest, and most active organization devoted to research on hormones, and the clinical practice of endocrinology. Endocrinologists are specially trained doctors who diagnose, treat and conduct basic and clinical research on complex hormonal disorders such as diabetes, thyroid disease, osteoporosis, obesity, hypertension, cholesterol and reproductive disorders. Today, The Endocrine Society's membership consists of over 11,000 scientists, physicians, educators, nurses and students, in more than 80 countries. Together, these members represent all basic, applied, and clinical interests in endocrinology. The Endocrine Society is based in Chevy Chase, Maryland. To learn more about the Society, and the field of endocrinology, visit the Society's web site at www.endo-society.org
Source: Endocrine Society Press Release: Friday October 3, 12:50 pm ET
Comments
I cannot believe what i have just read, unless of course i am rare. I was depressed and fat before T3, not depressed because i was fat but because no one believed how ill i felt. My mind was a fog and i could barely stay awake for longer than 4 hours. My quality of life was dire. Within 1 week of taking T3 my anti depressants were not needed, my life was worth living and many of my symptoms dissapeared. Over the 8 months i have been taking T3 i am back to my normal weight without any diets.I am also back to work part time. I am slowly getting my health back which is wonderful after having been neglected for 4 years. Perhaps these studies should include people who have trouble converting T4 to T3 because believe me there are many of us out there who continue to suffer on T4 alone. Offering people like myself T4 only is tantamount to cruelty and all who believe otherwise has obviously never had someone close to them suffer enough to draw such a conclusion. I cannot believe that that a common condition is so badly treated, my Endrochronologist gave me an appointment for 12 months time after i told him how ill i felt, and now he would have appeared to sack me from my 12 monthly appointments after i sought help from a private doctor. I am so annoyed with the NHS tratment i have received and having to fight for sickness benefits as i was too ill to work. I oly wish i could give these people a tablet so that they could be left for at least 12 months feeling the way i felt.
i too cannot tell you how much T3 has improved my life. I eel like a light has gone on most of my symptoms have diappeared and my weight has returned to the way it is. Who were these people in the study? I was obviously having problems converting but alas my GP just wanted to hand out antideppressants like smarties. 5 days into taking T3 they were no longer needed. Thank God for the Docs who stick out their neks.
How do i find a dr that will stick out his neck. I was told by a therapist that before antidepressants came about they didnt bother with a blood test. The Dr. said oh your depressed and you have gained weight? Low thyroid is your problem and would adjust the medication according to what the patient said they felt was needed. And what 5 or 6 yrs ago they adjusted the level of the blood test in favor of not needing as much. Hope that sounds right…anyway…i am having lots of problems getting high enough dosage..any sugestions?
I, too, felt like crap on synthroid alone. I approached my very good doctor about switching to Armour in July. I immediately lost 10 lbs over 8 weeks, a before unheard of event since the onset of Hashimoto’s. There are indeed people who have difficulty converting and it’s a shame that more doctors aren’t open minded when it comes to treatment. How do you find these docs? Ask around. Don’t be afraid to switch. I was actually told by a “thyorid specialist” that he could predict my dosage based on age, weight, etc. and I was right where I needed to be. But, I think to appease me, he would go ahead and check my levels. Guess who was right? Not him. My primary recently told me he finds endos to be extremely difficult to deal with. I’m sticking with him
I can’t believe these “research” results.
My daughter, 14yrs old, sufferred severely painful and heavy periods prior to T3 treatment. Her menstrual cycles became immediately improved when T3 was added. Definitely more female related research is warranted here!
I couldn’t agree more…I’ve gone from Synthriod alone to Synthriod plus Cytomel and now back to Synthriod alone at the strong recommendation of my doctor. Back once again are the typical symptoms; brain fog, lack of emotions and sluggishness. What do we do? Does Cytomel really increase the risk of heart problems?
I strongly agree with the comments above. I had misdiagnosed hypothyroid for years, was told I had heart problems and inherited high cholesterol….and the list goes by the brilliant medical doctors and specialists of Australia (not). I eventually found a wonderful holistic general physician who immediately diagnosed me as hypothyroid. I am still amazed how the preceding specialists and general practitioners had missed this diagnosis. I had very minimal response to T4 and when started on T3 this helped greatly. But I still did not feel well. When my Dr (based on blood tests) included T4 with my T3 for the first time in years I feel well and I am loving it. The scary part about the position proposed by these studies is that my effective treatment might be considered bad practice and withheld from me. Some of the issues not clear in the study relate to the client sample and interpretation of results. An alternate explanation for the results reported on this site is that for people who respond to T4 it seems rather silly to include T3. A better design might be to target patients who do not respond to T4 therapy alone and try an and/or/ and combined T3-T4 trail. Assuming that the reported trials used slow release T3 (the only form known to maintain significant stable levels in the blood) another critique of the studies is possible. These studies deal with treatment response as mean scores of symptom change, meaning the combined treatment didn’t make a difference for the majority of patients. This would be an expected result as the combined therapy might be most beneficial for those who don’t respond to t4. Hypothyroidism is understood relatively well as a pathology, but clinical management is not well understood. Clinically there are people who don’t fit the average hypothyroid treatment picture. Why some people need supraphysiological levels of T3 and sometimes combined t4 (or natural thyroid extract) to feel well is not well understood.
Which is better? Using Armour or using a combination of T3 and T4? Ive been on synthroid for 10 years and feel okay BUT have not been able to lose weight and feel achy in my muscles much of the time.
I also can’t believe this study. adding cytomel completely changed my life. With T4 alone I continued to display symptoms of hypothyroid. With combination therapy I am healthy, cholesterol levels and everything are perfect!
I cannot believe what I just read, either. I had the radioactive iodine in 1968, struggled all these years with just Synthroid. I did some research, discussed this with my doctor. I suggested Cytomel along with the Synthroid. She put me on the lowest dose, (5). The first morning I took it I felt a “lift” after about 20 minutes, but then a few hours later, I was so tired that I didn’t think I was going to make it through my workday. When I arrived home I immediately went to bed, as I was cold and soooooooo tired. The next day I took the AM dose and in the PM, before I felt my “dropoff,” I took the second one. It made all the difference in the world. I will continue to take it twice a day, along with my Synthroid. Quality of life is very important to me, which I didn’t have before. I couldn’t even remember my neighbors names, but now, I can tell you their phone numbers, birthdays, etc. I will continue to take both.
I wonder if there has been a new study since then?
I was on Synthroid for 6 yrs and then after baby #3 came along I found a dr that put me on Armour (t3/t4 combo). I did great for about 9 months. Lost all the extra weight, fatigue was gone, blood pressure down etc. Then I went hyper and another dr put me back on synt. Put 10lbs back on and while the mental clarity is better I am having all the symptoms of before. Dry hair, skin, bloated horrible cramps, and on and on. I have finally found a dr that will add t3 to the t4…we will see if it helps. I am pretty sure that is will since I loved the Armour but my hormones kept changing. We will see.
After being on Synthroid for 5 years, my doctor recommended adding 5 mcgs Cytomel. (My t4 levels were great, however my t3 was off and he believed I may have some conversion issues). My mental clarity DID increase. However, I gained 6 lbs in the first week, experienced body aches, hair loss and difficulty falling asleep. I think great attention must be given to dosage because the symptoms of overmedication can mimic hypothyrodism.
Look at the study; it is based on
I had most of my thyroid removed about 15 years ago after the birth of my first child – they put me on Levoxyl and about 4 years and two more children, into it, I was frustrated to tears about not feeling well – never to the point of staying in bed, but just groggy and gross – they even diagnosed me with chronic fatigue syndrome as all my thyroid tests kept coming back within range. I met a Doctor and mentioned my symptoms and he told me about the conversion issues and Cytomel therapy, which I pursued… I have felt back to my old self since – I couldn’t believe the difference those little pills made. I was able to be an energetic fun mum again. I believe that anyone who has to have their thyroid checked regularly should have their T3 and T4 levels checked, which most places don’t do unless it is requested. Not sure why their study showed those results, but, the way it was explained to me is that some people’s liver’s get the synthetic hormone and it doesn’t know what to do with it because it is synthetic, so the liver dumps it rather than converting it to what we need. Cytomel (or an equivalent) may not be for everyone who is hypothyroid – but for many, especially with conversion issues, a Godsend!
My entire thyroid was removed at age 26, due to thyroid cancer. For 21 long years, I obediently obeyed different doctors (including an endocronologist) as they kept me on only synthroid. Despite relaying my symptoms of being depressed, brain fog, and lack of engery, I finally accepted that this “is just the way it is.” I no longer respect these doctors. They stood before me with their thyroids in their necks properly functioning, and continued to ignore my symptoms. This last month, I went to another doctor and demanded they put me on something else (armour thyroid). The first day, I could tell a total difference, as if being reborn. The world looked brighter, and I actually began to enjoy life. Shame on the medical society, every one of them sure that they are right, while ignoring the true study-the patients such as myself who have endured the ego’s of doctors dictating as if they are God.
I don’t care what their study shows, all I know is I was on T4 synthroid and felt awful. Now I am taking T3/T4 Armour Thyroid and I am getting better each day.
There is never any discussion about how they do the studies. I doubt seriously they included people they new would benefit from T3 treatment. Dessicated thyroid is always better than T4/T3 as it also contains many other things the thyroid produces but some people (I think who have a pork allergy) don’t seem to benefit from it. I don’t know why this site seems to be so anti-appropriate thyroid treatment, but most people who need thyroid need T3 or Armour. And they need a hell of a lot more than the 2% Mary seems to think is adequate. I was a doctor for 17 years ridiculed by endocrinologists who thought treating people with Armour was unsafe and idiotic, yet my patients felt better. LISTEN: there is no reason not to feel good, find a doctor who will listen and isn’t afraid to help you.
Jeff — are you actually reading the site? This is a report on a research study — it is not my opinion. But if you read the articles at the site, I am quite vocal about patients having options, including natural thyroid, and everyone — except you, perhaps?
– knows that I personally take natural thyroid — have for years. In fact, the conventional endocrinologists are always attacking me, because they think this site is totally alternative — and not conventional.
And where did you get the idea about “the 2% Mary seems to think is adequate?” This is not true.
Each person needs the T4/T3 that they need — no formula, no cookie cutter.
I think we’re on the same side, but you don’t know it!!