Targeting the right population for T3 + T4 combined therapy: where are we now and where to next?
Tommaso PorcelliDomenico SalvatorePublished in: Endocrine (2020)
The universal applicability of levothyroxine (LT4) monotherapy for the treatment of hypothyroidism has been questioned in recent years. Indeed, it is now clear that about 10-15% of LT4-treated hypothyroid patients are dissatisfied with their treatment. It is plausible that this subset of hypothyroid patients may need T3 + T4 combined therapy to restore peripheral euthyroidism. To address this issue, many clinical trials have investigated the effect of T3 + T4 combinations versus standard LT4-based therapy. However, to date, results have been inconclusive, mainly due to the lack of markers that identify candidates for combination therapy. A breakthrough in this field came with the recent finding that several single-nucleotide polymorphisms in the deiodinase genes are associated with the persistence of hypothyroid symptoms in biochemically euthyroid LT4-treated patients, and are thus markers of candidates for combination therapy. In addition, whole-genome association studies are expanding our knowledge of other genes of the thyroid hormone (TH) pathway that affect serum TH levels. To target the right population for the T3 + T4 combined therapy, the next step is to translate these new findings into prospective trials. Hopefully, this will pave the way to personalized therapy for each hypothyroid patient.
Keyphrases
- combination therapy
- end stage renal disease
- newly diagnosed
- ejection fraction
- clinical trial
- chronic kidney disease
- healthcare
- peritoneal dialysis
- prognostic factors
- stem cells
- physical activity
- high resolution
- depressive symptoms
- mass spectrometry
- cell therapy
- drug delivery
- patient reported
- bone marrow
- study protocol
- case report
- atomic force microscopy
- bioinformatics analysis
- genome wide analysis