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Endocrine Abstracts (2015) 39 EP127 | DOI: 10.1530/endoabs.39.EP127

BSPED2015 e-Posters Thyroid (10 abstracts)

Combination T3/T4 therapy in paediatric patients with autoimmune hypothyroidism unresponsive to T4 therapy alone

Victoria Price , Hussain Alsaffar , Poonam Dharmaraj & Renuka Ramakrishnan


Alder Hey Children’s Hospital, Liverpool, UK.


Introduction: We do not fully understand why some hypothyroid patients complain of persistent symptoms despite normalisation of TSH with levothyroxine therapy. Recent evidence in adults suggests that polymorphism in deiodinase2 enzyme could lead to lower level of T3 in some tissues and persistence of symptoms. A combination therapy with T3/T4 may improve symptoms especially psychological well-being, mood and memory in such patients. Combination therapy is used in adults but rarely in children.

Methods: We describe two patients with autoimmune hypothyroidism who responded well to combination therapy with T3 and T4.

Results: Case 1: Despite normalisation of TSH, HT complained of low mood, poor memory and tiredness, affecting her school performance. With increasing doses of levothyroxine, she had transient symptomatic relief only. After exclusion of alternative causative pathology, liothyronine (T3) was added with significant improvement of her symptoms and patient-reported quality of life.

Case 2: BB also continued to be symptomatic despite increasing doses of levothyroxine, and the TSH continued to be marginally high. T3 was added to her therapy with good effect and patient-reported improvement in quality of life.

At DiagnosisOn T4 treatmentOn T3/T4 treatmentCurrent treatmentQOL for patient and family
PatientfT4 (9–19 pmol/l)TSH (0.3–3.8 mu/l)T4TSH T3 (1.3–2.5 nmol/l)T4TSHT3T4 (mcg)T3 (mcg)
Case 1 14.4 yearsUnknownUnknown24.1*<0.03*2.314.30.882.675 OD10 TDSImproved
Case 2 12 years5.7029611.614.011.58.82.911.675 OD10, 20 BDImproved
*Noted to be overtreated

Discussion/conclusion: Our paediatric patients with autoimmune hypothyroidism showed a good symptomatic response to T3/T4 combination treatment after a limited response to T4 alone. Both patients opted to continue combination treatment despite increased frequency of dosing.

Volume 39

43rd Meeting of the British Society for Paediatric Endocrinology and Diabetes

British Society for Paediatric Endocrinology and Diabetes 

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