Use Of Liothyronine Research Articles

Use of thyroid hormones in hypothyroid and euthyroid patients: A survey of members of the Endocrine Society of Australia.

Hypothyroidism is a common endocrine condition usually managed with levothyroxine (LT4). However, controversy remains around the use of liothyronine (LT3). We aimed to investigate the practices of Australian endocrinologists when managing patients with hypothyroidism, their use of LT3 + LT4 combination therapy and use of thyroid hormones in euthyroid patients. Members of the Endocrine Society of Australia (ESA) were invited to participate in an online questionnaire. We analysed questionnaires that had complete demographic data. Eighty-seven questionnaires fulfilled the criteria. LT4 was used as first line treatment for hypothyroidism by all respondents. Only 45% reported that their patients were dispensed the brand of LT4 that they recommend. LT3 (alone or in combination) was prescribed by 44% in their clinical practice. Although 49% of respondents would consider LT3 + LT4 in patients with normal TSH who had ongoing symptoms of hypothyroidism, the inability of LT4 to restore normal physiology was ranked the least likely explanation for persistent symptoms and only 32% would consider it for themselves if they were diagnosed with hypothyroidism. The majority (55%), in accordance with evidence, would not prescribe thyroid hormone to euthyroid individuals but 39% would consider use in euthyroid female infertility with high levels of thyroid antibodies and 11% in euthyroid patients with a simple goitre growing over time. LT4 use in pregnancy was variable among members. Australian endocrinologists mostly follow international guidelines when prescribing thyroid hormone therapy and many prescribe combination LT3 and LT4 therapy, particularly for patients who remain symptomatic on LT4 monotherapy. Prescribing practices are largely similar to other countries who have completed similar questionnaires.

Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement.

Persistent symptoms in patients treated for hypothyroidism are common. Despite more than 20 years of debate, the use of liothyronine for this indication remains controversial, as numerous randomised trials have failed to show a benefit of treatment regimens that combine liothyronine (T3) with levothyroxine over levothyroxine monotherapy. This consensus statement attempts to provide practical guidance to clinicians faced with patients who have persistent symptoms during thyroid hormone replacement therapy. It applies to non-pregnant adults and is focussed on care delivered within the UK National Health Service, although it may be relevant in other healthcare environments. The statement emphasises several key clinical practice points for patients dissatisfied with treatment for hypothyroidism. Firstly, it is important to establish a diagnosis of overt hypothyroidism; patients with persistent symptoms during thyroid hormone replacement but with no clear biochemical evidence of overt hypothyroidism should first have a trial without thyroid hormone replacement. In those with established overt hypothyroidism, levothyroxine doses should be optimised aiming for a TSH in the 0.3-2.0 mU/L range for 3 to 6 months before a therapeutic response can be assessed. In some patients, it may be acceptable to have serum TSH below reference range (e.g. 0.1-0.3 mU/L), but not fully suppressed in the long term. We suggest that for some patients with confirmed overt hypothyroidism and persistent symptoms who have had adequate treatment with levothyroxine and in whom other comorbidities have been excluded, a trial of liothyronine/levothyroxine combined therapy may be warranted. The decision to start treatment with liothyronine should be a shared decision between patient and clinician. However, individual clinicians should not feel obliged to start liothyronine or to continue liothyronine medication provided by other health care practitioners or accessed without medical advice, if they judge this not to be in the patient's best interest.

Socioeconomic influence on treatment with liothyronine and desiccated thyroid extract in Denmark.

High compared with low educational level increases the odds of starting levothyroxine (L-T4) with a normal thyroid-stimulating hormone - the mechanism is most likely patient request. The use of liothyronine (L-T3) and desiccated thyroid extract (DTE) is also speculated to be initiated at patients' request. Therefore, the primary aim of this study was to evaluate if educational level influences treatment with L-T3 and DTE. In this register-based cross-sectional study, we included all Danish citizens ≥30 years with redeemed prescription of L-T4, L-T3, or DTE during 2017-2020. We defined educational levels as short, medium, and long (<10 years, 10-12 years, and above 12 years, respectively). The association between educational level and treatment with LT3 or DTE vs only LT4 was analyzed in logistic regression models adjusted for age and sex. We included 154,360 individuals using thyroid medication of whom 3829 were treated with L-T3 (2.48%) and 430 with DTE (0.28%). The usage was highest among women (3.15%) and the age group 40-49 (5.6%). Longer education compared with short increased the odds of being treated with DTE or L-T3 (medium education odds ratio (OR) 1.61 (95% CI 1.50-1.8) and long education OR 1.95 (95% CI 1.79-2.13)). Test for trend: OR: 1.37 (95% CI 1.31-1.42). Adjustment for other covariates did not affect the results substantially. Persons with a longer compared to a shorter education are more often treated with either DTE or L-T3, and the usage of these drugs is limited to less than 3% of thyroid hormone users.

Liothyronine use in primary hypothyroidism - current concepts.

Hypothyroidism is an endocrine disorder whose management raises many challenges in clinical practice. Its standard treatment is levothyroxine (LT4). The goal of the treatment is to normalize signs and symptoms, as well as to achieve thyroid-stimulating hormone (TSH) concentrations within the reference range, on an individual basis. It is known that 5-10% of hypothyroid patients remain symptomatic, despite achieving the target TSH levels, which, in turn, affects their quality of life. After ruling out other causes of non-thyroid origin for this persistence, it is suggested that these patients could benefit from the use of liothyronine (LT3), added to LT4, especially if polymorphism of the deiodinase 2 (D2) genes is documented. There exist a variety of LT3 preparations, whose concentrations vary from 5 to 50 ug, with the recommended LT4/LT3 ratio of 13:1-20:1. The goals of combination therapy should be to achieve a physiological ratio of free triiodothyronine/free thyroxine (FT3/FT4) and non-suppression of TSH. Because there is currently no guide that makes evidence-based recommendations on the use of LT3 in primary hypothyroidism, more clinical studies are needed to be able to identify hypothyroid patients who may benefit from the use of LT3, by identifying new biomarkers.

Trends in costs and prescribing for liothyronine and levothyroxine in England and wales 2011-2020.

Recent prescribing policies in England and Wales have imposed significant restrictions on liothyronine prescribing in general practice driven by the prohibitive costs and uncertain benefits of liothyronine in the management of hypothyroidism. However, the impact of these policies on liothyronine usage and costs is still unclear. Data were downloaded from the NHS monthly General Practice Prescribing Data in England and from the Comparative Analysis System for Prescribing Audit (CASPA) in Wales for 2011-2020. Trends over the period in amount and costs of levothyroxine and liothyronine prescribing were analysed. The total medication costs per year for England Wales for hypothyroidism rose from £60.8 million to £129.8 million in 2015-16 and have since reduced to £88.4 million. Levothyroxine prescriptions have been growing above the population growth rate at 0.7%/annum in England and 1.1% in Wales. The costs/patient/year for liothyronine rose from £550 to £3000 in 2015-16 and has since fallen to £2500. Use of liothyronine as a percentage of levothyroxine started to fall in 2015-16 at 7%/annum in England and 3% in Wales. Nevertheless, 0.5% of levothyroxine-treated patients continue to receive liothyronine. All Clinical Commission Groups (CCGs) in England continue to have at least one liothyronine prescribing practice and 48.5% of English general practices prescribed liothyronine in 2019-20. In spite of strenuous attempts to limit prescribing of liothyronine in general practice, a significant number of patients continue to receive this therapy. The price differential of liothyronine vs levothyroxine should be examined again in light of the continuing use of liothyronine.

An audit of the use of liothyronine (LT3) in the East Sussex Health Care Trust

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

The emergence of psychosis in a patient with severe hypothyroidism: A case report and literature review

Hypothyroidism is associated with changes in mental state that can range from mild cognitive impairment to depression to florid myxedema coma. A few cases have linked the occurence of psychotic symptoms in the context of severe hypothyroidism, an event referred in the literature as “myxedema madness”. We describe the case of a 48-year-old male with no past psychiatric history and a past medical history of hypertension and hypothyroidism who presented to the psychiatric unit for management of new-onset psychosis, particularly paranoid delusions. On basic medical screening, the patient was found to have severe hypothyroidism manifested by a TSH level of 51.85 and a free T4 level less than 0.4. The patient was treated with both an antipsychotic and thyroid hormone replacement, after which his hypothyroid symptoms and his psychosis improved. Liothyronine was also prescribed to speed up the recovery course, as his delusions were thought to be due to his hypothyroidism. The aim of this poster is to shed light on the possibility of development of psychosis concomitantly with severe hypothyroidism, given the rarity of such events, as well as to illustrate the importance of treating the underlying medical cause rather than only focusing on the treatment of the psychiatric symptoms. The use of Liothyronine proved to be beneficial in this case, as the patient's symptoms drastically improved after its administration. This could potentially illustrate the importance of using Liothyronine particularly in the treatment of delusional disorder in severe hypothyroidism.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Thyroid Replacement Therapy: The Hidden Challenges

Hypothyroidism has a gradual onset and non-specific symptoms, which might be subtle, and which might therefore be ignored or misdiagnosed. Subclinical hypothyroidism is a well-established phenomenon where a patient does not have thyroid symptoms, but shows biochemical evidences of hypothyroidism. However, diagnosis and treatment of these patients may prevent development of overt hypothyroidism and cardiovascular symptoms. Replacement therapy with levothyroxine (T4) is the treatment of choice for hypothyroidism; levothyroxine is taken daily, provides stable plasma levels and is suitable for the majority of patients. Patients with certain forms of hypothyroidism - central hypothyroidism, thyroidectomy patients and patients with “low T3 syndrome” - may benefit from treatment with liothyronine (T3), which is more potent and has a shorter onset of action. The use of liothyronine in combination with levothyroxine is controversial, but there is evidence that some patients, particularly those with deiodinase 2 and thyroid hormone transporter expression polymorphisms, may benefit from combination therapy. J Endocrinol Metab. 2013;3(6):127-131 doi: http://dx.doi.org/10.4021/jem200w

Use of liothyronine in preventing electroconvulsive therapy-induced memory impairment: evaluation

Aims and methodTo evaluate the effect of liothyronine administration on the cognitive side-effects of electroconvulsive therapy (ECT), 30 participants with major depressive disorder that were suitable candidates for ECT were randomly allocated to either a liothyronine or a placebo group. Participants in the liothyronine group received a daily 50 μg dose for the whole period of receiving ECT starting the day before ECT, whereas the other group received a placebo. The Hamilton Rating Scale for Depression (HRSD) and the Wechsler Memory Scale – revised (WMS-R) were used for evaluating mood and memory before the first ECT session and after the sixth session (the HRSD was also used after the third session).ResultsThe results indicated that after the sixth ECT session, participants that received liothyronine achieved significantly better scores on the HRSD and WMS-R.Clinical implicationsFurther studies with a larger number of participants, through multicentre research projects, are indicated to obtain adequate data for meta-analysis and systematic review.

Thyroid Replacement Therapy: The Hidden Challenges

Hypothyroidism has a gradual onset and non-specific symptoms, which might be subtle, and which might therefore be ignored or misdiagnosed. Subclinical hypothyroidism is a well-established phenomenon where a patient does not have thyroid symptoms, but shows biochemical evidences of hypothyroidism. However, diagnosis and treatment of these patients may prevent development of overt hypothyroidism and cardiovascular symptoms. Replacement therapy with levothyroxine (T4) is the treatment of choice for hypothyroidism; levothyroxine is taken daily, provides stable plasma levels and is suitable for the majority of patients. Patients with certain forms of hypothyroidism - central hypothyroidism, thyroidectomy patients and patients with “low T3 syndrome” - may benefit from treatment with liothyronine (T3), which is more potent and has a shorter onset of action. The use of liothyronine in combination with levothyroxine is controversial, but there is evidence that some patients, particularly those with deiodinase 2 and thyroid hormone transporter expression polymorphisms, may benefit from combination therapy. J Endocrinol Metab. 2013;3(6):127-131 doi: http://dx.doi.org/10.4021/jem200w

Use of Liothyronine To Improve Sperm Counts after Surgical Correction of Sterility

Use of Liothyronine To Improve Sperm Counts after Surgical Correction of Sterility

Treatment of chronic schizophrenics with liothyronine (L-triiodothyronine).

Half of the group of 24 showed temporary changes. These changes were maximal at the peak doses, either in the direction of decreased depression and withdrawal (8 cases) or increased restlessness and tension (4 cases). These changes were not lasting, and as the medication was decreased, the group as a whole returned to its original level. The temporary periods of improvement occurred in a peculiar cyclic pattern, lasting from a few days to a few weeks at a time. In higher doses the drug was accompanied by changes in the mood and activity of chronic schizophrenic patients, but did not bring about a lasting or dependable improvement in psychiatric status or hospital adjustment. The use of liothyronine in psychiatric disorders must still be considered in experimental stage.

Anastomosis of the Vas Deferens: An Experimental Study. II. Successes and Failures in Experimental Anastomosis

No AccessJournal of Urology1 Jan 1959Anastomosis of the Vas Deferens: An Experimental Study. II. Successes and Failures in Experimental Anastomosis Stanwood S. Schmidt Stanwood S. SchmidtStanwood S. Schmidt More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)65990-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1959 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byAmelar R and Dubin L (2018) Vasectomy ReversalJournal of Urology, VOL. 121, NO. 5, (547-550), Online publication date: 1-May-1979.Fallon B, Jacobo E and Bunge R (2018) Restoration of Fertility by VasovasostomyJournal of Urology, VOL. 119, NO. 1, (85-86), Online publication date: 1-Jan-1978.Hagan K and Coffey D (2018) The Adverse Effects of Sperm During VasovasostomyJournal of Urology, VOL. 118, NO. 2, (269-273), Online publication date: 1-Aug-1977.Derrick F, Yarbrough W and D’agostino J (2018) Vasovasostomy: Results of Questionnaire of Members of the American Urological AssociationJournal of Urology, VOL. 110, NO. 5, (556-557), Online publication date: 1-Nov-1973.Fernandes M, Shah K and Draper J (2018) Vasovasostomy: Improved Microsurgical TechniqueJournal of Urology, VOL. 100, NO. 6, (763-766), Online publication date: 1-Dec-1968.Faulkner J (2018) Use of Liothyronine To Improve Sperm Counts after Surgical Correction of SterilityJournal of Urology, VOL. 88, NO. 2, (262-265), Online publication date: 1-Aug-1962.Waller J and Turner T (2018) Anastomosis of the Vas after VasectomyJournal of Urology, VOL. 88, NO. 3, (409-410), Online publication date: 1-Sep-1962.Schmidt S (2018) Anastomosis of the Vas Deferens: An Experimental Study. IV. The Use of Fine Polyethylene Tubing as a SplintJournal of Urology, VOL. 85, NO. 5, (838-841), Online publication date: 1-May-1961. Volume 81Issue 1January 1959Page: 203-205 Advertisement Copyright & Permissions© 1959 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Stanwood S. Schmidt More articles by this author Expand All Advertisement PDF downloadLoading ...