Combination Thyroxine + T3 treatment in hypothyroidism – ETA guidelines 2012 help prescribing in hypothyroidism

Combination treatment with thyroxine and T3 has always remained controversial and uncommon (particularly the armour treatment) and the reluctance of endocrinologists to prescribe (which is very understandable). The controversy i.e. the paucity of evidence in medical  literature to support T4+T3 treatment – Vs – persistence of symptoms on adequate treatment with thyroxine (despite normal TSH) and reported improvement with addition of T3 in some patients were a potential conundrum to be solved to improve patient outcomes.

The 2012 ETA guidelines help solve a part of this puzzle (task force recommendations include the following) provided normal TSH on thyroxine (T4) and adequate patient support to deal with the chronic nature of hypothyroidism

  1. Exclude other associated auto-immune diseases
  2. Start combination treatment with T4 + T3 with a dose ratio of T4:T3 between 13:1 to 20:1 under follow-up of a trained specialist / endocrinologist with close monitoring of Free T4, Free T3 and TSH
  3. Aiming for normal serum TSH and Free T4:Free T3 ratios AND
  4. Discontinue T3 treatment after 3 months if no improvement is perceived.

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