Treating T3 Deficiency, The Evidence You Need Part 3

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.

Objectives:

Upon completion of this thyroidectomy treatment option workshop, the healthcare professional will be able to:

1. Review the literature demonstrating that levothyroxine therapy (T4-alone) does not improve symptoms after thyroid gland removal.
2. 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.
3. Recall the serum levels of Free T3 were not achieved despite TSH suppression with T4 Levothyroxine.
4. 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.
5. 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.
6. Review that this accounts for many patients not achieving symptom improvement, patient satisfaction or serum lipids using T4 alone therapy.  T4 also increased BMI.
7. Identify why the T4/T3 trials were designed to fail.
8. 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.
9. 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.
10. 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.