Kalra Sanjay, Mithal Ambrish, Wangnoo Subhash K, Seshadri Krishna, Dharmalingnam Mala
Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India.
Institute of Endocrinology and Diabetes, Max Healthcare, Saket, India.
Indian J Endocrinol Metab. 2025 Jul-Aug;29(4):402-407. doi: 10.4103/ijem.ijem_294_24. Epub 2025 Aug 26.
The management of hypothyroidism is based on the assumption that levothyroxine monotherapy normalizes thyroid hormone homeostasis, rendering patients clinically and biochemically euthyroid. However, a subset of patients treated with levothyroxine (LT4) are dissatisfied as they continue to have symptoms such as fatigue, weight gain, and difficulty in concentration. Some patients do not achieve normalization of thyroid-stimulating hormone despite adherence to adequate LT4 dosing. It has been proposed that liothyronine (LT3) may benefit such patients. This review addresses the specific role of LT3 in the management of hypothyroidism with an emphasis on practical considerations and a focus on appropriate patient selection. It identifies clinical challenges where patient outcomes are improved by adding LT3 to LT4 therapy, including myxedema coma, preoperative management, and situations where swift resolution of hypothyroidism is warranted. Further, it addresses the challenges faced in dose titration of LT4 and LT3 and the importance of monitoring therapy with LT3.
甲状腺功能减退症的管理基于这样一种假设，即左甲状腺素单一疗法可使甲状腺激素稳态正常化，使患者在临床和生化方面处于甲状腺功能正常状态。然而，一部分接受左甲状腺素（LT4）治疗的患者并不满意，因为他们仍然有疲劳、体重增加和注意力不集中等症状。尽管坚持使用足够剂量的LT4，一些患者的促甲状腺激素仍未恢复正常。有人提出，碘塞罗宁（LT3）可能使这类患者受益。本综述阐述了LT3在甲状腺功能减退症管理中的具体作用，重点是实际考虑因素，并着重于合适的患者选择。它确定了通过在LT4治疗中添加LT3可改善患者预后的临床挑战，包括黏液性水肿昏迷、术前管理以及需要迅速解决甲状腺功能减退症的情况。此外，它还阐述了LT4和LT3剂量滴定中面临的挑战以及监测LT3治疗的重要性。
