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Abstract

Background

Combination therapy with levothyroxine (L-T4) and slow-release T3 (SRT3) in the treatment of hypothyroidism results in a normal triiodothyronine/thyroxine (T3/T4) ratio above that of L-T4 monotherapy. No clinical study has been reported on SRT3 monotherapy for hypothyroidism.

Methods

This study was conducted in two parts. In the first part, 20 patients with primary hypothyroidism and serum thyrotropin (TSH) >30 mU/L were randomized into three groups receiving 1.6 μg/kg L-T4, equivalent doses of SRT3 or L-T3 of 0.55 μg/kg for 4 weeks. Their fasting serum-free T4 [fT4], T3, and TSH were measured weekly before taking medication for up to 4 weeks. In the second part, in 9 hypothyroid patients on L-T4 therapy and normal serum TSH, L-T4 therapy was discontinued, and a once-daily dose of SRT3 of 0.55 μg/kg was replaced. Serum fT4, T3, and TSH were measured weekly.

Results

In , in patients treated with L-T3 and L-T4, serum TSH decreased to normal values after 4 weeks of intervention. In 7 patients on SRT3, serum T3 increased from 47±12 at baseline to 110±16 ng/dL, and serum TSH decreased from 60±11 at baseline to 24±10 and 26±7 mU/L, respectively, at 14 and 21 days after intervention. At the end of 28 days, mean serum T3 was 110±16, 168±74, and 96±18 ng/dL in SRT3, L-T3, and L-T4 groups, respectively ( < 0.001). In , serum fT4 decreased from 1.43±0.7 to 0.41±0.14 ng/dl, and serum T3 increased from 86±21 to 113±27 ng/dL by 21 days. Mean serum TSH remained normal until 14 days but increased to 15.1±7.6 mU/L at 21 days. In the end, mean serum fT4, T3, and TSH were 0.35±0.17 ng/dl, 77.4±8.9 ng/dL, and 35±11 mU/L, respectively.

Conclusion

In patients with primary hypothyroidism, SRT3 monotherapy with an equivalent dose to L-T4 maintained normal serum T3 but could not sustain normal serum TSH concentration.

Clinical Trial Study

IRCT20100922004794N12.

© 2025 The Author(s). Published by Bentham Science Publishers
This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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2025-01-21
2025-07-29

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Treatment of Primary Hypothyroidism by Slow-Release Liothyronine Monotherapy
Bentham Science Publishers ; https://doi.org/10.2174/0118715303321830241227112420
/content/journals/emiddt/10.2174/0118715303321830241227112420
/content/journals/emiddt/10.2174/0118715303321830241227112420
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  • Article Type:     Research Article
Keywords: slow-release liothyronine ; clinical trial ; levothyroxine ; therapy ; Hypothyroidism

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