Additional research is also needed to develop thyroid hormone analogs with a favorable benefit to risk profile. Some examples of future research needs include the development of superior biomarkers of euthyroidism to supplement thyrotropin measurements, mechanistic research on serum triiodothyronine levels (including effects of age and disease status, relationship with tissue concentrations, as well as potential therapeutic targeting), and long-term outcome clinical trials testing combination therapy or thyroid extracts (including subgroup effects).
We found no consistently strong evidence for the superiority of alternative preparations (e.g., levothyroxine–liothyronine combination therapy, or thyroid extract therapy, or others) over monotherapy with levothyroxine, in improving health outcomes. The second category included thyroid extracts, synthetic combination therapy, triiodothyronine therapy, and compounded thyroid hormones.Ĭonclusions: We concluded that levothyroxine should remain the standard of care for treating hypothyroidism. Results: We reviewed the following therapeutic categories: (i) levothyroxine therapy, (ii) non–levothyroxine-based thyroid hormone therapies, and (iii) use of thyroid hormone analogs. Consensus was achieved for all recommendations by the task force. Stakeholder input was received at a national meeting, with some subsequent refinement of the clinical questions addressed in the document. The final document was organized so that each topic is introduced with a question, followed by a formal clinical recommendation. For clinical recommendations, the supporting evidence was appraised, and the strength of each clinical recommendation was assessed, using the American College of Physicians system. When responses were not suitable for a formal clinical recommendation, a summary response statement without a formal clinical recommendation was developed. The responses to questions were formatted, when possible, in the form of a formal clinical recommendation statement. Ethics reviews were provided, when relevant, by a bioethicist. Clinical reviews were supplemented, when relevant, with related mechanistic and bench research literature reviews, performed by our team of translational scientists.
The clinical literature relating to each question was then reviewed. Methods: Task force members identified 24 questions relevant to the treatment of hypothyroidism. This document is intended to inform clinical decision-making on thyroid hormone replacement therapy it is not a replacement for individualized clinical judgment. We wished to determine whether there are sufficient new data generated by well-designed studies to provide reason to pursue such therapies and change the current standard of care. The purpose of this task force was to review the goals of levothyroxine therapy, the optimal prescription of conventional levothyroxine therapy, the sources of dissatisfaction with levothyroxine therapy, the evidence on treatment alternatives, and the relevant knowledge gaps. Background: A number of recent advances in our understanding of thyroid physiology may shed light on why some patients feel unwell while taking levothyroxine monotherapy.
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