Context: NICE and BTA agrees that combination L T4 and LT3 can be used in patients with symptoms persisting after adequate use of LT4.
Methods: We retrospectively audited the patients coming to the endocrine clinics of ESHT whether they followed the local agreed protocol of LT3 usage. We checked if they had:
1. Initiation of LT4 by an endocrine specialist.
2. If other causes of tiredness were ruled out.
3. If LT4 doses were adequately decreased on starting LT3.
4. If they were on combination therapy or just LT3.
We also looked at symptoms that caused them to be put on LT3 and whether they improved. We also looked at the levels of TSH, fT4 and fT3 before and after initiation of LT3.
|12 patients who used T3 were studied. 9 patients were still on it.|
|8/12 ( 67% )of T3 initiation was by consultants, 2/12(16%) was by Gps, 1 was unknown and 1 was over the counter.|
|All patients noticed improvement in symptoms after starting T3 and wanted to continue.|
|5/12 (42%) had appropriate reduction in LT4 on initiation of LT3. 7/12, (58%) didnt.|
|11/12 (92%) had other causes of fatigue ruled out.|
|7/12 (58%) were overreplaced even before T3 initiation, but symptomatic.|
|2/12 (16%) were undereplaced and 3/12 (25%) had normal TFTs.|
|The overreplaced patients remained with suppressed TSH after T3 start.|
|8/12 (67%) had suppressed TSH after combination therapy. 4/12 (33%) had normal TFTs.|
|3 patients came off T3 treatment; 2 because their CCG wouldnt prescribe and one had cardiac morbidity.|
Conclusions: Stricter adherence to guidelines on initiation of LT3 is required. Overreplacement and suppression of TSH is a risk. Patients felt symptom relief and most wanted to stay on the combination treatment.