Many patients continue complaining of subjective symptoms of hypothyroidism despite being on adequate doses of levothyroxine. There are about 14 studies involving T3+T4 combination including 7 which were rigorously conducted. Majority of them (11 studies) did not show any benefit of combination therapy. But our local experience has been a little different. We looked at small cohort of 15 patients who were on combination T3+T4 for more than 6 months and were asked to give their self assessments with respect to physical well being, mental concentration and somatic symptoms (brittle nails, hair fall, dry skin, constipation) before and after starting T3+T4 treatment.
2/3rd of all patients had improvements in symptoms after starting combination treatment. 33% (5patients) stated HUGE improvements in their symptoms, 20% (3patients) reported SIGNIFICANT improvements while 13% (2patients) reported SOME improvements. There were 2 patients (13%) who claimed to have NO improvements at all and another 2 (13%) did not attend the clinic. 1 patient (7%) said she could not decide whether there was any improvement or not.
Conclusion: With 33% of patients stating huge & 20% reporting significant improvements, a total of 53% patients in this audit showed good improvement in their symptoms with combination therapy. Therefore T4+T3 combination was a good option for treating more than half of the euthyroid patients who continued to complain of subjective symptoms of an under active thyroid. Hence we recommend a trial of T3 T4 combination therapy for all patients who have persistent subjective symptoms despite being adequately replaced with thyroxine.