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Endocrine

Erschienen in:

01.08.2019 | Review

Thyroid hormone therapy for hypothyroidism

verfasst von: Bernadette Biondi, David S. Cooper

Erschienen in: Endocrine | Ausgabe 1/2019

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Abstract

The purpose of this article will be to review the basics of thyroid hormone therapy, including various thyroid hormone formulations, the institution and monitoring of thyroid hormone therapy, adverse effects of overtreatment, the management of patients with persistent symptoms despite normal thyroid function tests, and potential new innovations in thyroid hormone therapy. The conclusions support the necessity to personalize thyroid hormone replacement therapy in hypothyroid patients.

A. Gruters, H. Krude, Detection and treatment of congenital hypothyroidism. Nat. Rev. Endocrinol. 18, 104–113 (2012)CrossRef

W.M. Tunbridge, D.C. Evered, R. Hall et al. The spectrum of thyroid disease in a community: the Whickham survey. Clin. Endocrinol. 7, 481–493 (1977)CrossRef

J.G. Hollowell, N.W. Staehling, W.D. Flanders et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J. Clin. Endocrinol. Metab. 87, 489–499 (2002)CrossRefPubMed

G.J. Canaris, N.R. Manowitz, G. Mayor, E.C. Ridgway, The Colorado thyroid disease prevalence study. Arch. Intern. Med. 160, 526–534 (2000)CrossRefPubMed

J. Doucet, C. Trivalle, P. Chassagne et al. Does age play a role in clinical presentation of hypothyroidism? J. Am. Geriatr. Soc. 42, 984–986 (1994)CrossRefPubMed

B. Biondi, A.R. Cappola, D.S. Cooper, Subclinical Hypothyroidism: A Review. JAMA 322, 153–160 (2019).CrossRefPubMed

A.P. Bremner, P. Feddema, P.J. Leedman et al. Age-related changes in thyroid function: a longitudinal study of a community-based cohort. J. Clin. Endocrinol. Metab. 97, 1554–62 (2012)CrossRefPubMed

T. Vadiveloo, P.T. Donnan, M.J. Murphy, G.P. Leese, Age- and gender-specific TSH reference intervals in people with no obvious thyroid disease in Tayside, Scotland: the thyroid epidemiology, audit, and research study (TEARS). J. Clin. Endocrinol. Metab. 98, 1147–1153 (2013)CrossRefPubMed

H.S. Ahn, D.W. Kim, Y.J. Lee, H.J. Baek, J.H. Ryu, Diagnostic accuracy of real-time sonography in differentiating diffuse thyroid disease from normal thyroid parenchyma: a multicenter study. AJR Am. J. Roentgenol. 211, 649–654 (2018)CrossRefPubMed

10.

O. Koulouri, C. Moran, D. Halsall, K. Chatterjee, M. Gurnell, Pitfalls in the measurement and interpretation of thyroid function tests. Best. Pract. Res. Clin. Endocrinol. Metab. 27, 745–762 (2013)CrossRefPubMedPubMedCentral

11.

N. Hattori, T. Ishihara, K. Yamagami, A. Shimatsu, Macro TSH in patients with subclinical hypothyroidism. Clin. Endocrinol. 83, 923–930 (2015)CrossRef

12.

J.R. Garber, R.H. Cobin, H. Gharib, American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults et al., Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid 22, 1200–1235 (2012).CrossRefPubMed

13.

J. Jonklaas, A.C. Bianco, A.J. Bauer, American Thyroid Association Task Force on Thyroid Hormone Replacement et al., Guidelines for the treatment of hypothyroidism: prepared by the American thyroid association task force on thyroid hormone replacement. Thyroid 24, 1670–751 (2014).CrossRefPubMedPubMedCentral

14.

B. Biondi, D.S. Cooper, The clinical significance of subclinical thyroid dysfunction. Endocr. Rev. 29, 76–131 (2008)CrossRefPubMed

15.

D.S. Cooper, B. Biondi, Subclinical thyroid disease. Lancet 379(9821), 1142–1154 (2012)CrossRefPubMed

16.

N. Rodondi, W.P. den Elzen, D.C. Bauer, Thyroid Studies Collaboration et al., Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA 304, 1365–1374 (2010).CrossRefPubMedPubMedCentral

17.

B. Gencer, T.H. Collet, V. Virgini, Thyroid Studies Collaboration et al., Subclinical thyroid dysfunction and the risk of heart failure events: an individual participant data analysis from 6 prospective cohorts. Circulation 126, 1040–1049 (2012).CrossRefPubMed

18.

S.H. Pearce, G. Brabant, L.H. Duntas et al. 2013 ETA guideline: management of subclinical hypothyroidism. Eur. Thyroid J. 2, 215–218 (2013)CrossRefPubMedPubMedCentral

19.

G. Brenta, M. Vaisman, J.A. Sgarbi et al. Task Force on Hypothyroidism of the Latin American Thyroid Society (LATS). Clinical practice guidelines for the management of hypothyroidism. Arq. Bras. Endocrinol. Metabol. 57, 265–291 (2013)

20.

G.E. Bekkering, T. Agoritsas, L. Lytvyn et al. Thyroid hormones treatment for subclinical hypothyroidism : a clinical practice guideline. BMJ 14(365), l2006 (2019)CrossRef

21.

J. Lazarus, R.S. Brown, C. Daumerie, A. Hubalewska-Dydejczyk, R. Negro, B. Vaidya,European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur. Thyroid J. 3, 76–94 (2014)CrossRefPubMedPubMedCentral

22.

E.K. Alexander, E.N. Pearce, G.A. Brent et al. 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 27, 315–389 (2017)CrossRefPubMed

23.

M. Fleseriu, J.A. Hashim, N. Karavitaki et al. Hormonal replacement in hypopituitarism in adults: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 101, 3888–3921 (2016)CrossRefPubMed

24.

B. Biondi, L. Wartofsky, Treatment with thyroid hormone. Endocr. Rev. 35, 433–512 (2014)CrossRefPubMed

25.

T.D. Hoang, C.H. Olsen, V.Q. Mai, P.W. Clyde, M.K. Shakir, Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism:a randomized, double-blind, crossover study. J. Clin. Endocrinol. Metab. 98, 1982–1990 (2013)CrossRefPubMed

26.

B. Biondi, L. Bartalena, L. Chiovato et al. “Recommendations for treatment of hypothyroidism with levothyroxine and levotriiodothyronine: a 2016 position statement of the Italian Society of Endocrinology and the Italian Thyroid Association”. J. Endocrinol. Investig. 39, 1465–1474 (2016)CrossRefPubMed

27.

J.I. Mechanick, E.M. Brett, A.B. Chausmer, R.A. Dickey, S. Wallach, American Association of Clinical Endocrinologists, American Association of Clinical Endocrinologists medical guidelines for the clinical use of dietary supplements and nutraceuticals. Endocr. Pract. 9, 417–470 (2003).CrossRefPubMed

28.

L.E. Braverman, S.H. Ingbar, K. Sterling, Conversion of thyroxine (T4) to triiodothyronine (T3) in athyreotic human subjects. J. Clin. Investig. 49, 855–864 (1970)CrossRefPubMedPubMedCentral

29.

R. Vita, S. Benvenga, Tablet levothyroxine (l-T4) malabsorption induced by proton pump inhibitor; a problem that was solved by switching to l-T4 in soft gel capsule. Endocr. Pract. 20, e38–41 (2014)CrossRefPubMed

30.

C. Virili, P. Trimboli, F. Romanelli, M. Centanni, Liquid and softgel levothyroxine use in clinical practice: state of the art. Endocrine 54, 3–14 (2016)CrossRefPubMed

31.

J.V. Hennessey, A.O. Malabanan, B.R. Haugen, E.G. Levy, Adverse event reporting in patients treated with levothyroxine: results of the pharmacovigilance task force survey of the American Thyroid Association, American Association of Clinical Endocrinologists, and the Endocrine Society. Endocr. Pract. 16, 357–370 (2010)CrossRefPubMed

32.

L. Wartofsky, Levothyroxine: therapeutic use and regulatory issues related to bioequivalence. Expert Opin. Pharmacother. 3, 727–732 (2002)CrossRefPubMed

33.

F.S. Celi, M. Zemskova, J.D. Linderman et al. Metabolic effects of liothyronine therapy in hypothyroidism: a randomized, double-blind, crossover trial of liothyronine versus levothyroxine. J. Clin. Endocrinol. Metab. 96, 3466–3474 (2011)CrossRefPubMedPubMedCentral

34.

W.M. Wiersinga, L. Duntas, V. Fadeyev, B. Nygaard, M.P. Vanderpump, ETA guidelines: the use of l-T4 + l-T3 in the treatment of hypothyroidism. Eur. Thyroid J. 1, 55–71 (2014)CrossRef

35.

L. Bartalena, E. Martino, A. Pacchiarotti et al. Factors affecting suppression of endogenous thyrotropin secretion by thyroxine treatment: retrospective analysis in athyreotic and goitrous patients. J. Clin. Endocrinol. Metab. 64, 849–855 (1987)CrossRefPubMed

36.

L. Persani, Clinical review: central hypothyroidism: pathogenic, diagnostic, and therapeutic challenges. J. Clin. Endocrinol. Metab. 97, 3068–3078 (2012)CrossRefPubMed

37.

J. Jonklaas, Sex and age differences in levothyroxine dosage requirement. Endocr. Pract. 16, 71–79 (2010)CrossRefPubMed

38.

F. Santini, A. Pinchera, A. Marsili et al. Lean body mass is a major determinant of levothyroxine dosage in the treatment of thyroid diseases. J. Clin. Endocrinol. Metab. 90, 124–127 (2005)CrossRefPubMed

39.

M. Devdhar, R. Drooger, M. Pehlivanova, G. Singh, J. Jonklaas, Levothyroxine replacement doses are affected by gender and weight, but not age. Thyroid 21, 821–827 (2011)CrossRefPubMedPubMedCentral

40.

V. Fonseca, M. Thomas, A. Katrak, P. Sweny, J.F. Moorhead, Can urinary thyroid hormone loss cause hypothyroidism? Lancet 24(8765), 475–476 (1991). 338CrossRef

41.

N.A. Junglee, M.F. Scanlon, D.A. Rees, Increasing thyroxine requirements in primary hypothyroidism: don't forget the urinalysis! J. Postgrad. Med. 52, 201–203 (2006)PubMed

42.

N. Jassam, T.J. Visser, T. Brisco et al. Consumptive hypothyroidism: a case report and review of the literature. Ann. Clin. Biochem. 48, 186–189 (2011)CrossRefPubMed

43.

J.W. De Groot, T.P. Links, W.T. van der Graaf, Tyrosine kinase inhibitors causing hypothyroidism in a patient on levothyroxine. Ann. Oncol. 17, 1719–1720 (2006)CrossRefPubMed

44.

P. Kundra, K.D. Burman, The effect of medications on thyroid function tests. Med. Clin. North Am. 96, 283–295 (2012)CrossRefPubMed

45.

M. Skelin, T. Lucijanić, D. Amidžić Klarić et al. Factors affecting gastrointestinal absorption of levothyroxine: a review. Clin. Ther. 39, 378–403 (2017)CrossRefPubMed

46.

L. Liwanpo, J.M. Hershman, Conditions and drugs interfering with thyroxine absorption. Best. Pract. Res Clin. Endocrinol. Metab. 23, 781–792 (2009)CrossRefPubMed

47.

J.C. Morris, How do you approach the problem of TSH elevation in a patient on highdose thyroid hormone replacement? Clin. Endocrinol. 70, 671–673 (2009)CrossRef

48.

T.G. Bach-Huynh, B. Nayak, J. Loh, S. Soldin, J. Jonklaas, Timing of levothyroxine adminis-tration affects serum thyrotropin concentration. J. Clin. Endocrinol. Metab. 94, 3905–3912 (2009)CrossRefPubMedPubMedCentral

49.

N. Bolk, T.J. Visser, J. Nijman et al. Effects of evening vs morning levothyroxine intake: a randomized double-blind crossover trial. Arch. Intern. Med. 170, 1996–2003 (2010)CrossRefPubMed

50.

H.M. Robertson, A.K. Narayanaswamy et al. Factors contributing to high levothyroxine doses in primary hypothyroidism: an interventional audit of a large community database. Thyroid 24, 1765–1771 (2014)CrossRefPubMed

51.

M. Centanni, L. Gargano, G. Canettieri et al. Thyroxine in goiter, Helicobacter pylori infection, and chronic gastritis. N. Engl. J. Med. 354, 1787–1795 (2006)CrossRefPubMed

52.

S. Benvenga, L. Bartolone, M.A. Pappalardo et al. Altered intestinal absorption of l-thyroxine caused by coffee. Thyroid 18, 293–301 (2008)CrossRefPubMed

53.

P. Gargiulo, L. Gargano, M. Centanni, Atypical celiac disease as cause of increased need for thyroxine: a systematic study. J. Clin. Endocrinol. Metab. 97, E419–422 (2012)CrossRefPubMed

54.

M. Cellini, M.G. Santaguida, I. Gatto et al. Systematic appraisal of lactose intolerance as cause of increased need for oral thyroxine. J. Clin. Endocrinol. Metab. 99(8), E1454–1458 (2014)CrossRefPubMed

55.

S.K. Grebe, R.R. Cooke, H.C. Ford, J.N. Fagerström, D.P. Cordwell, N.A. Lever, G.L. Purdie, C.M. Feek, Treatment of hypothyroidism with once weekly thyroxine. J. Clin. Endocrinol. Metab. 82, 870–875 (1997)PubMed

56.

C. Virili, M. Centanni, Does microbiota composition affect thyroid homeostasis? Endocrine 49, 583–587 (2015)CrossRefPubMed

57.

A. Lobasso, L. Nappi, L. Barbieri et al. Severe hypothyroidism due to the loss of therapeutic efficacy of l-thyroxine in a patient with esophageal complication associated with systemic sclerosis. Front. Endocrinol. (Lausanne) 8, 241 (2017)CrossRef

58.

M. McMillan, K.S. Rotenberg, K. Vora et al. Comorbidities, concomitant medications, and diet as factors affecting. Levothyroxine therapy: results of the CONTROL surveillance project. Drugs R D 16, 53–68 (2016)CrossRefPubMed

59.

S.A. Irving, T. Vadiveloo, G.P. Leese, Drugs that interact with levothyroxine: an observational study from the Thyroid Epidemiology, Audit and Research Study (TEARS). Clin. Endocrinol 82, 136–141 (2015)CrossRef

60.

M.G. Santaguida, C. Virili, S.C. Del Duca et al. Thyroxine softgel capsule in patients with gastric-related T4 malabsorption. Endocrine 49, 51–57 (2015)CrossRefPubMed

61.

C. Virili, L. Giovanella, P. Fallahi et al. Levothyroxine therapy: changes of TSH levels by switching patients from tablet to liquid formulation. a systematic review and meta-analysis. Front. Endocrinol. 9, 10 (2018)CrossRef

62.

R. Vita, G. Saraceno, F. Trimarchi, S. Benvenga, Switching levothyroxine from the tablet to the oral solution formulation corrects the impaired absorption of levothyroxine induced by proton-pump inhibitors. J. Clin. Endocrinol. Metab. 99, 4481–4486 (2014)CrossRefPubMed

63.

R. Vita, G. Saraceno, F. Trimarchi, S. Benvenga, A novel formulation of l-thyroxine (T4) reduces the problem of T4 malabsorption by coffee observed with traditional tablet formulations. Endocrine 43, 154–160 (2013)CrossRefPubMed

64.

C. Cappelli, I. Pirola, L. Daffini et al. A double-blind placebo-controlled trial of liquid thyroxine ingested at breakfast: results of the TICO study. Thyroid 26, 197–202 (2016)CrossRefPubMed

65.

P. Fierabracci, S. Martinelli, A. Tamberi et al. Weight loss and variation of levothyroxine requirements in hypothyroid obese patients after bariatric surgery. Thyroid 26, 499–503 (2016)CrossRefPubMed

66.

S. Gadiraju, C.J. Lee, D.S. Cooper, Levothyroxine dosing following bariatric surgery. Obes. Surg. 26, 2538–2542 (2016)CrossRefPubMed

67.

K.B. Ain, S. Refetoff, H.G. Fein, B.D. Weintraub, Pseudomalabsorption of levothyroxine. JAMA 266, 2118–1220 (1991)CrossRefPubMed

68.

D.J. Lips, M.T. van Reisen, V. Voigt, W. Venekamp, Diagnosis and treatment of pseudomalabsorption. Neth. J. Med. 62, 114–118 (2004)PubMed

69.

J.N. Walker, P. Shillo, V. Ibbotson et al. A thyroxine absorption test followed by weekly thyroxine administration: a method to assess non-adherence to treatment. Eur. J. Endocrinol. 168, 913–917 (2013)CrossRefPubMed

70.

S. Rangan, A.A. Tahrani, A.F. Macleod, P.K. Moulik, Once weekly thyroxine treatment as a strategy to treat non-compliance. Postgrad. Med J. 83(984), e3 (2007)CrossRefPubMed

71.

V. Eligar, P.N. Taylor, O.E. Okosieme, G.P. Leese, C.M. Dayan, Thyroxine replacement: a clinical endocrinologist's viewpoint. Ann. Clin. Biochem. 53(Pt 4), 421–433 (2016)CrossRefPubMed

72.

K. Andersson, A. Melander, C. Svensson, O. Lind, J.L. Nilsson, Repeat prescriptions: refill adherence in relation to patient and prescriber characteristics, reimbursement level and type of medication. Eur. J. Public Health 15, 621–626 (2005)CrossRefPubMed

73.

L.L. Somwaru, A.M. Arnold, N. Joshi, L.P. Fried, A.R. Cappola, High frequency of and factors associated with thyroid hormone over-replacement and under-replacement in men and women aged 65 and over. J. Clin. Endocrinol. Metab. 94, 1342–1345 (2009)CrossRefPubMedPubMedCentral

74.

C.T. Sawin, T. Herman, M.E. Molitch, M.H. London, S.M. Kramer, Aging and the thyroid. Decreased requirement for thyroid hormone in older hypothyroid patients. Am. J. Med. 75, 206–209 (1983)CrossRefPubMed

75.

T.O. Obisesan, M.H. Aliyu, V. Bond, R.G. Adams, A. Akomolafe, C.N. Rotimi, Ethnic and age-related fat free mass loss in older Americans: the Third National Health and Nutrition Examination Survey (NHANES III). BMC Public Health 5, 41 (2005)CrossRefPubMedPubMedCentral

76.

M.T. Hays, K.R. Nielsen, Human thyroxine absorption: age effects and methodological analyses. Thyroid 4, 55–64 (1994)CrossRefPubMed

77.

M. Centanni, M. Marignani, L. Gargano et al. Atrophic body gastritis in patients with autoimmune thyroid disease: an underdiagnosed association. Arch. Intern Med. 159, 1726–1730 (1999)CrossRefPubMed

78.

S. Checchi, A. Montanaro, L. Pasqui et al. l-thyroxine requirement in patients with autoimmune hypothyroidism and parietal cell antibodies. J. Clin. Endocrinol. Metab. 93, 465–469 (2008)CrossRefPubMed

79.

J.J. Scargill, M. Livingston, D. Holland, C.J. Duff, A.A. Fryer, A.H. Heald, Monitoring thyroid function in patients on levothyroxine. Assessment of Conformity to National Guidance and Variability in Practice. Exp. Clin. Endocrinol. Diabetes 125, 625–633 (2017)CrossRefPubMed

80.

U.M. Kabadi, Variability of l-thyroxine replacement dose in elderly patients with primary hypothyroidism. J. Fam. Pract. 24, 473–477 (1987)PubMed

81.

P.N. Taylor, C. Minassian, R.A. Rehman et al. TSH levels and risk of miscarriage in women on long-term levothyroxine: a community-based study. J. Clin. Endocrinol. Metab. 99, 3895–902 (2014)CrossRefPubMed

82.

R.W. Flynn, S.R. Bonellie, R.T. Jung, T.M. MacDonald, A.D. Morris, G.P. Leese, Serum thyroid-stimulating hormone concentration and morbidity from cardiovascular disease and fractures in patients on long-term thyroxine therapy. J. Clin. Endocrinol. Metab. 95, 186–193 (2010)CrossRefPubMed

83.

E.N. Klein Hesselink, M.S. Klein Hesselink, G.H. de Bock et al. Long-term cardiovascular mortality in patients with differentiated thyroid carcinoma: an observational study. J. Clin. Oncol. 31, 4046–4053 (2013)CrossRefPubMed

84.

M.R. Blum, D.C. Bauer, T.H. Collet, H.A. Fink,Thyroid Studies Collaboration et al., Subclinical thyroid dysfunction and fracture risk: a meta-analysis. JAMA 313, 2055–2065 (2015).CrossRefPubMedPubMedCentral

85.

K.H. Winther, P. Cramon, T. Watt et al. Disease-specific as well as generic quality of life is widely impacted in autoimmune hypothyroidism and improves during the first six months of levothyroxine therapy. PLoS ONE 11, e0156925 (2016)CrossRefPubMedPubMedCentral

86.

E.A. McAninch, A.C. Bianco, The history and future treatment of hypothyroidism. Ann. Intern. Med. 164, 50–56 (2016)CrossRefPubMedPubMedCentral

87.

S.J. Peterson, A.R. Cappola, M.R. Castro et al. Degrees of satisfaction and coexistent diseases in those responding to a survey exploring perceptions about treatment of hypothyroidism. Thyroid 28, 707–721 (2018)CrossRefPubMedPubMedCentral

88.

L.F. Michaelsson, B.B. Medici, J.L. la Cour et al. Treating hypothyroidism with thyroxine/triiodothyronine combination therapy in Denmark: following guidelines or following trends?. Eur. Thyroid J. 4, 174–180 (2015)CrossRefPubMedPubMedCentral

89.

J. Jonklaas, E. Tefera, N. Shara, Physician choice of hypothyroidism therapy: influence of patient characteristics. Thyroid 28, 1416–1424 (2018)CrossRefPubMedPubMedCentral

90.

O. Okosieme, J. Gilbert, P. Abraham et al. Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee. Clin. Endocrinol. 84, 799–808 (2016)CrossRef

91.

J. Jonklaas, B. Davidson, S. Bhagat, S.J. Soldin, Triiodothyronine levels in athyreotic individuals during levothyroxine therapy. JAMA 299, 769–777 (2008)CrossRefPubMed

92.

M. Ito, A. Miyauchi, S. Morita T et al. TSH-suppressive doses of levothyroxine are required to achieve preoperative native serum triiodothyronine levels in patients who have undergone total thyroidectomy. Eur. J. Endocrinol. 167, 373–378 (2012)CrossRefPubMed

93.

J. Jonklaas, Persistent hypothyroid symptoms in a patient with a normal thyroid stimulating hormone level. Curr. Opin. Endocrinol. Diabetes Obes. 24, 356–363 (2017)CrossRefPubMedPubMedCentral

94.

A.C. Biancom, B.W. Kim, Deiodinases: implications of the local control of thyroid hormone action. J. Clin. Investig. 116, 2571–2579 (2006)CrossRef

95.

A.C. Bianco, Pathophysiological relevance of deiodinase polymorphism. Curr. Opin. Endocrinol. Diabetes Obes. 25, 341–346 (2018). BWCrossRefPubMedPubMedCentral

96.

B.C. Appelhof, R.P. Peeters, W.M. Wiersinga et al. Polymorphisms in type 2 deiodinase are not associated with well-being, neurocognitive functioning, and preference for combined thyroxine/3,5,3'-triiodothyronine therapy. J. Clin. Endocrinol. Metab. 90, 6296–6299 (2005)CrossRefPubMed

97.

A. Carle, J. Faber, R. Steffensen, P. Laurberg, B. Nygaard, Hypothyroid patients encoding combined MCT10 and DIO2 gene polymorphisms may prefer l-T3 + l-T4 combination treatment—data using a blind, randomized clinical study. Eur. Thyroid J. 6, 143–151 (2017)CrossRefPubMedPubMedCentral

98.

W.M. Wiersinga, Therapy of endocrine disease: T4 + T3 combination therapy: is there a true effect? Eur. J. Endocrinol. 177, R287–R296 (2017)CrossRefPubMed

99.

J.C. Galofré, J.J. Díez, D.S. Cooper, Thyroid dysfunction in the era of precision medicine. Endocrinol. Nutr. 63(7), 354–363 (2016)CrossRefPubMed

100.

P.W. Ladenson, Precision medicine comes to thyroidology. J. Clin. Endocrinol. Metab. 101, 799–803 (2016)CrossRefPubMed

Titel: Thyroid hormone therapy for hypothyroidism
verfasst von: Bernadette Biondi
David S. Cooper
Publikationsdatum: 01.08.2019
Verlag: Springer US
Erschienen in: Endocrine / Ausgabe 1/2019
Print ISSN: 1355-008X
Elektronische ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-019-02023-7

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