Dr. Rouzier does a literature review of how to treat patients after a thyroidectomy and the best treatment options for these patients. How these patients are not able to raise Free T3 levels post-surgery and treating with T4 alone does not improve symptoms. In addition, we will be discussing some of the problems of why some patients are not able to achieve a therapeutic level of Free T3. By treating patients with DTE, patient symptoms are reduced and improved compared to T4 and T4/T3 combinations therapies.
Upon completion of this thyroidectomy treatment option workshop, the healthcare professional will be able to:
- Review the literature demonstrating that levothyroxine therapy (T4-alone) does not improve symptoms after thyroid gland removal.
- Evaluate thyroid hormone levels before and after surgery demonstrating the inability to raise Free T3 levels after surgery to pre-surgery levels using T4-alone therapy.
- Recall the serum levels of Free T3 were not achieved despite TSH suppression with T4 Levothyroxine.
- Critique the meta-analysis of T4/T3 trials that demonstrate the ineffectiveness of adding T3 to T4. However, the ratio used was 14/1 whereas studies demonstrate the need to use 3/1 ratio in order to achieve therapeutic equivalency.
- Discuss the inadequate achievement of therapeutic levels of Free T3 due to 1) decreased gland production of T3 and 2) downregulation of D2 deiodinase enzyme pathway to T4.
- Review that this accounts for many patients not achieving symptom improvement, patient satisfaction or serum lipids using T4 alone therapy. T4 also increased BMI.
- Identify why the T4/T3 trials were designed to fail.
- Describe the mechanism of inadequate tissue levels of T3 as being the cause of persistent symptoms on T4 alone. However, AACE recommends against testing for Free T3 levels.
- Discuss why levothyroxine remains the standard therapy for treating hypothyroidism and the many studies that support that opinion. Nevertheless, other studies support the superiority of DTE.
- Review the recent studies demonstrating that a combination therapy for T4/T3 is different than DTE. Use of DTE provides improved patient satisfaction over T4-alone as well as T4/T3 combinations.