Thyroxine vs thyroxine plus triiodothyronine in treatment of hypothyroidism after thyroidectomy for graves’ disease

Abstract

It was recently demonstrated that treatment with levorotatory thyroxine (T₄) plus triodotthyronine (T₃) compared with treatment with T₄ alone improves psychologic functioning in hypothyroid patients with thyroid cancer or autoimmune thyroiditis. In the present double-blind crossover study, we again compared the effects of combined thyroid replacement vs monotherapy on psychologic function, endocrine function, cardiovascular function, and body composition. The patients were women who were hypothyroid after thyroidectomy for Graves’ disease. The substitution of 10 µg of T₃ for 50 µg of T₄ caused a statistically significant decrease in free T₄ concentration but no significant change in T₃ or thyroid-stimulating hormone concentration. Symptoms of hypothyroidism and of hyperthyroidism tended to decrease on a standard symptom scale after combined treatment. With combined hormone replacement, mental state tended to improve on some mood scales but not on cognitive tests. We found alterations in left ventricular diastolic function but no change in body composition after the combined treatment regimen. These preliminary findings in a small group of patients with Graves’ disease are consistent with earlier findings that thyroid replacement with T₄-T₃ combination improves mental functioning.