Part-of-the-Day Hypertriiodothyroninemia Caused by Desiccated Thyroid
Abstract
To the Editor.— Thyroxine (T4) can provide all the body needs in thyroid hormones. Nevertheless, desiccated thyroid is still widely used, although it causes hypertriiodothyroninemia lasting several hours in healthy subjects1and in many, although not all, patients with hypothyroidism.2,3The relation of elevated triiodothyronine (T3) levels to the time of the administration of the drug to the patients was not reported. Recently, we encountered several patients treated with desiccated thyroid who complained of nervousness, palpitations, and tremor appearing only in the morning, with tachycardia present or absent depending on the time of their visits. Although the fasting levels of both T4and T3were normal, we found elevated T3levels three hours after the patients took their thyroid medication. Thereafter, we evaluated predose and postdose serum T3levels in 21 consecutive patients taking desiccated thyroid. Patients.— The patients (20 women and one
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Patients receiving DTE exhibit an elevation in serum T3 that peaks at about 3 hours after taking the tablet.
“patients receiving DTE exhibit an elevation in serum T3 that peaks at about 3 hours after taking the tablet”
From Liothyronine and Desiccated Thyroid Extract in the Treatment of Hypothyroidism (2020) · cites this paper as [57]
In DTE patients, serum T3 might fluctuate above the upper limit of the reference range depending on the dose taken.
“this might fluctuate above the upper limit of the reference range depending on the dose taken”
From Liothyronine and Desiccated Thyroid Extract in the Treatment of Hypothyroidism (2020) · cites this paper as [57]
In DTE patients, serum T3 returns to within normal range 12-24 hours after the last dose.
“serum T3 returns to within normal range 12–24 hours after the last dose.”
From Liothyronine and Desiccated Thyroid Extract in the Treatment of Hypothyroidism (2020) · cites this paper as [57]
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Stagnaro-Green, A., Abalovich, M., Alexander, E., Azizi, F., Mestman, J., Negro, R., Nixon, A., Pearce, E. N., Soldin, O. P., Sullivan, S., et al. (2011) · Thyroid · doi:10.1089/thy.2011.0087 · Cited by 2,942 · see citing works
Alexander, E. K., Pearce, E. N., Brent, G. A., Brown, R. S., Chen, H., Dosiou, C., Grobman, W. A., Laurberg, P., Lazarus, J. H., Mandel, S. J., et al. (2017) · Thyroid® · doi:10.1089/thy.2016.0457 · Cited by 2,731 · see citing works
Jonklaas, J., Bianco, A. C., Bauer, A. J., Burman, K. D., Cappola, A. R., Celi, F. S., Cooper, D. S., Kim, B. W., Peeters, R. P., Rosenthal, M. S., et al. (2014) · Thyroid® · doi:10.1089/thy.2014.0028 · Cited by 1,928 · see citing works
The emergence of levothyroxine as a treatment for hypothyroidism
Hennessey, J. V. (2017) · Endocrine · doi:10.1007/s12020-016-1199-8 · Cited by 66 · see citing works
Dayan, C., & Panicker, V. (2018) · Thyroid Research · doi:10.1186/s13044-018-0045-x · Cited by 62 · see citing works
Liothyronine and Desiccated Thyroid Extract in the Treatment of Hypothyroidism
Idrees, T., Palmer, S., Maciel, R. M. B., & Bianco, A. C. (2020) · Thyroid® · doi:10.1089/thy.2020.0153 · Cited by 58 · see citing works
Thyroxine and treatment of hypothyroidism: seven decades of experience
Mateo, R. C. I., & Hennessey, J. V. (2019) · Endocrine · doi:10.1007/s12020-019-02006-8 · Cited by 57 · see citing works
Single-Dose T3 Administration: Kinetics and Effects on Biochemical and Physiological Parameters
Jonklaas, J., Burman, K. D., Wang, H., & Latham, K. R. (2015) · Therapeutic Drug Monitoring · doi:10.1097/ftd.0000000000000113 · Cited by 49 · see citing works
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Patient Experiences and Perceptions Associated with the Use of Desiccated Thyroid Extract
Toloza, F. J. K., Espinoza Suarez, N. R., El Kawkgi, O., Golembiewski, E. H., Ponce, O. J., Yao, L., Maraka, S., Singh Ospina, N. M., & Brito, J. P. (2020) · Medicina · doi:10.3390/medicina56040161 · Cited by 22 · see citing works
Levothyroxine sodium pentahydrate tablets – formulation considerations
Kaur, N., & Suryanarayanan, R. (2021) · Journal of Pharmaceutical Sciences · doi:10.1016/j.xphs.2021.08.006 · Cited by 19 · see citing works
- Authors
- Lev-Ran, A.
- Corresponding author
- Lev-Ran, Arye
- Venue
- JAMA: The Journal of the American Medical Association
- Publisher
- American Medical Association (AMA)
- Published
- 1983-11-25
- Volume
- 250
- Issue
- 20
- Pages
- 2790
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2022753725
- Cited by
- 18
- References
- 0
- Citations by year
- 2025: 1 · 2024: 1 · 2021: 1 · 2020: 2 · 2019: 2 · 2018: 2 · 2017: 1 · 2016: 3 · 2015: 2 · 2014: 2
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- desiccated thyroid, triiodothyronine, hypothyroidism, thyroid hormone replacement, morning symptoms, tachycardia
- MeSH terms
- Adult, Aged, Circadian Rhythm, Female, Humans, Hypothyroidism, Male, Middle Aged, Thyroid (USP), Thyroid Hormones, Triiodothyronine
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