Benefits and Harms of Levothyroxine/L-Triiodothyronine Versus Levothyroxine Monotherapy for Adult Patients with Hypothyroidism: Systematic Review and Meta-Analysis
Open accessAbstract
Background: Combined therapy with levothyroxine (LT4)/L-triiodothyronine (LT3) has garnered attention among clinicians and patients as a potential treatment alternative to LT4 monotherapy. The objective of this study was to compare the benefits and harms of LT4/LT3 combined therapy and LT4 monotherapy for patients with hypothyroidism. Methods: A systematic search in MEDLINE, Scopus, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials was performed by a librarian from inception date until September 2020. Randomized clinical trials and quasiexperimental studies comparing combined therapy (LT4/LT3) versus monotherapy (LT4) for adult patients with hypothyroidism were considered for inclusion. Independent data extraction was performed by paired reviewers. A meta-analysis comparing standardized mean differences of the effect of each therapy was performed on clinical outcomes and patient preferences. Proportions of adverse events and reactions were assessed narratively. Results: A total of 1398 references were retrieved, from which 18 fulfilled the inclusion criteria. Results supported by evidence at low-to-moderate certainty evidence did not display a difference in treatment effect between therapies on clinical status, quality of life, psychological distress, depressive symptoms, and fatigue; all measured with standardized questionnaires. Furthermore, meta-analysis of patient preferences revealed higher proportions of choice for combined therapy (43%) when compared with monotherapy (23%) or having no preference (30%). When evaluating treatment adverse events or adverse reactions, similar proportions were observed between treatment groups; meta-analysis was not possible. Conclusions: The available evidence at low-to-moderate certainty demonstrates that there is no difference in clinical outcomes between LT4/LT3 combined therapy and LT4 monotherapy for treating hypothyroidism in adults, except for a higher proportion of patient preferring combined therapy. Adverse events and reactions appear to be similar across both groups, however, this observation is only narrative. These results could inform shared decision-making conversations between patients with hypothyroidism and their clinicians. PROSPERO Registration ID: CRD42020202658.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Patient preference for combined therapy over T4 alone often arises from subjective improvements in symptoms like fatigue and cognitive function.
“Despite mixed results in clinical trials, patient preference for combined therapy over T4 alone often arises from subjective improvements in symptoms like fatigue and cognitive function, which are not consistently quantifiable by standard clinical parameters [31].”
From Evaluating the effectiveness of combined T4 and T3 therapy or desiccated thyroid versus T4 monotherapy in hypothyroidism: a systematic review and meta-analysis (2024) · cites this paper as [31]
The Discussion and Results report that patients preferred combined therapy more often than T4 monotherapy (43% versus 23%). They do not establish that this preference arose from perceived improvements in fatigue or cognitive function: the Results found no difference in questionnaire-measured fatigue and lacked data on cognitive outcomes. The claim about improvements not being consistently quantifiable by standard clinical parameters is therefore not established by this review. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAlmost all blinded RCTs showed that QoL improved during combined liothyronine/levothyroxine treatment, but that it also improved to the same degree during levothyroxine monotherapy, demonstrating the strong placebo effect of thyroid hormones.
“Almost all these blinded RCTs showed that QoL improved during combined liothyronine/levothyroxine treatment, but that it also improved to the same degree during levothyroxine monotherapy, demonstrating the strong placebo effect of thyroid hormones.”
From Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement (2023) · cites this paper as [12]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredFour systematic reviews/meta-analyses of these trials found no clear benefit of combination liothyronine/levothyroxine replacement over levothyroxine monotherapy in terms of mood, health-related QoL or cognitive function.
“four systematic reviews/meta -analyses 12,44 -46 of these trials found no clear benefit of combination liothyronine/levothyroxine replacement over levothyroxine monotherapy in terms of mood, health -related QoL or cognitive function.”
From Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement (2023) · cites this paper as [12]
The Discussion reports no difference between combination therapy and monotherapy for quality of life, psychological distress, and depression. However, the Results state that the review could not obtain data on cognitive parameters, so this source does not support the cognitive-function part of the claim. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThese trials were of short duration, used varying liothyronine dosing schedules, and mostly measured only resting heart rate and blood pressure as safety endpoints.
“However, these trials were of short duration, used varying liothyronine dosing schedules, and mostly measured only resting heart rate and blood pressure as safety endpoints. 9 -12”
From Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement (2023) · cites this paper as [12]
The Results report treatment durations of 5 weeks to 12 months, and the Discussion says more than half the studies lasted 12 weeks or less and used differing T4:T3 dose ratios (page numbers unavailable). The paper does not establish that trials mostly measured only resting heart rate and blood pressure as safety endpoints; its Results also report adverse reactions and treatment discontinuations. (LLM, conf=0.87)
Experimental — accuracy not yet measuredSystematic reviews on LT3 safety are limited and have been confined to analyses of short-term adverse outcomes in treatment efficacy trials.
“Systematic reviews on LT3 safety are limited and have been confined to the analyses of short-term adverse outcomes in treatment efficacy trials (11, 12).”
From Risk of Death and Adverse Effects in Patients on Liothyronine: A Multisource Systematic Review and Meta-analysis (2025) · cites this paper as [11]
The Discussion (page unavailable) says this was the first review to summarize adverse events or reactions across clinical trials of LT4/LT3 combined therapy and notes that more than half the trials had follow-up of 12 weeks or less. That supports limited, largely short-term safety evidence from treatment trials, but it does not establish that systematic reviews of LT3 safety in general have been confined to such analyses. (LLM, conf=0.82)
Experimental — accuracy not yet measured
These previous meta-analyses were limited to trials that met criteria for efficacy analysis.
“However, these meta-analyses were limited to trials that met criteria for efficacy analysis.”
From Risk of Death and Adverse Effects in Patients on Liothyronine: A Multisource Systematic Review and Meta-analysis (2025) · cites this paper as [11]
The Discussion (page unavailable) says previous meta-analyses addressed clinical outcomes and describes this review as the first to assess clinical outcomes, patient preferences, and adverse events together. It does not say that the earlier meta-analyses limited trial inclusion to studies meeting criteria for efficacy analysis; the Results describe such exclusions only for this review's own meta-analysis. (LLM, conf=0.76)
Experimental — accuracy not yet measuredCombination levothyroxine and liothyronine (LT4+LT3) therapy is safe in patients with hypothyroidism.
“Randomized clinical trials including all types of patients with hypothyroidism revealed that combination levothyroxine and liothyronine (LT4+LT3) therapy is safe and is the preferred choice of patients versus LT4 alone.”
From Emerging Therapies in Hypothyroidism (2024) · cites this paper as [16]
The Conclusion (page not specified) says adverse events and reactions appeared similar with LT4+LT3 and LT4 alone, but explicitly calls this a narrative observation. The Results report adverse-event withdrawals in both groups, and the Discussion notes that follow-up of 12 weeks or less in over half the studies may be insufficient to assess safety. The evidence therefore supports comparable observed short-term harms, not an unqualified claim that combination therapy is safe. (LLM, conf=0.88)
Experimental — accuracy not yet measuredA recent meta-analysis of 18 randomized controlled trials comparing LT4+LT3 versus LT4 for adult patients with hypothyroidism obtained low- to moderate-certainty evidence that no differences exist in treatment effect between therapies regarding clinical status, quality of life, psychological distress, depressive symptoms, and fatigue.
“A recent meta-analysis of 18 RCTs comparing LT4+LT3 versus LT4 for adult patients with hypothyroidism examined clinical outcomes and patient preferences (16). The authors obtained low- to moderate-certainty evidence that no differences exist in treatment effect between therapies regarding clinical status, quality of life, psychological distress, depressive symptoms, and fatigue.”
From Emerging Therapies in Hypothyroidism (2024) · cites this paper as [16]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredAnalysis of 18 randomized controlled trials found that similar proportions of adverse events or reactions were observed between LT4 and LT4+LT3 treatment groups.
“On the contrary, analysis of 18 RCTs found that similar proportions of adverse events or reactions were observed between LT4 and LT4+LT3 treatment groups (16).”
From Emerging Therapies in Hypothyroidism (2024) · cites this paper as [16]
The Results section reports that adverse-event incidence did not appear to differ between treatments, but says this was a narrative judgment without a statistical comparison. It also identifies 18 included studies, of which 17 were RCTs and one was quasiexperimental; adverse-event data came from subsets of those studies, not all 18. (LLM, conf=0.92)
Experimental — accuracy not yet measuredMultiple randomized controlled trials and large retrospective studies show that therapy containing T3 is as safe as therapy with LT4.
“While the multiple RCTs and large retrospective studies show that therapy containing T3 is as safe as therapy with LT4, the 2014 American Thyroid Association clinical guidelines for the treatment of hypothyroidism called for the development of new T3 formulations that would avoid the swings in serum T3 levels observed with the current T3-containing formulations, i.e., LT3 or DTE.”
From Emerging Therapies in Hypothyroidism (2024) · cites this paper as [16]
The Results section (page not provided) says adverse-event rates in the reviewed trials did not appear to differ between LT4/LT3 combination therapy and LT4 monotherapy, but no statistical comparison was performed. The paper reviewed trials, not large retrospective studies, and its Conclusion describes the safety finding as narrative rather than establishing that T3-containing therapy is equally safe. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe RCTs consistently demonstrated that L-T4 and L-T4 + L-T3 treatments were both equally effective based on patient-reported outcomes (PROs), such as questionnaires evaluating quality of life, mood, and cognition.
“The RCTs, which spanned up to several months, consistently demonstrated that L-T4 and L-T4 + L-T3 treatments were both equally effective based on patient-reported outcomes (PROs), such as questionnaires evaluating quality of life (QoL), mood, and cognition.”
From Treatment Preferences in Patients With Hypothyroidism (2025) · cites this paper as [8]
The Results (Clinical outcomes) report no differences between therapies on questionnaire measures of quality of life, psychological distress, and depression. But the review could not obtain data for cognitive parameters, so it does not support the claim about cognition; its pooled finding also does not establish that every RCT found equal outcomes. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe incidence of adverse effects/reactions indicated that L-T4 and L-T4 + L-T3 treatments were equally safe for patients with hypothyroidism.
“Moreover, the incidence of adverse effects/reactions indicated that both treatments were equally safe for patients with hypothyroidism (7,8).”
From Treatment Preferences in Patients With Hypothyroidism (2025) · cites this paper as [8]
The Discussion reports that adverse-event and adverse-reaction incidence did not appear to differ substantially between groups, but says no statistical comparisons were performed. The Conclusion likewise describes the similarity as a narrative observation. That supports an apparent similarity in reported events, not the stronger conclusion that the treatments were equally safe. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe other 2 meta-analyses by Millan-Alanis et al and Lan et al did not consider patient preference as a primary objective, and neither focused on randomized RCTs.
“The other 2 meta-analyses by Millan-Alanis et al (8) and Lan et al (7) did not consider patient preference as a primary objective, and neither focused on randomized RCTs.”
From Treatment Preferences in Patients With Hypothyroidism (2025) · cites this paper as [8]
The Introduction (page unavailable) names comparison of treatment benefits and harms—not patient preference—as the review’s primary aim, although Methods says preference was evaluated. The claim that the review did not focus on randomized trials is not supported: Methods explicitly includes RCTs, and Results reports that 17 of the 18 included studies were RCTs. This verdict addresses Millan-Alanis et al.; this source cannot establish Lan et al.’s objectives. (LLM, conf=0.88)
Experimental — accuracy not yet measuredNumerous randomised trials have failed to show a benefit of treatment regimens that combine liothyronine (T3) with levothyroxine over levothyroxine monotherapy.
“numerous randomised trials have failed to show a benefit of treatment regimens that combine liothyronine (T3) with levothyroxine over levothyroxine monotherapy.”
From Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement (2023) · cites this paper as [12]
Adverse-event risks in randomized controlled trials were only specifically addressed in a few previous systematic reviews.
“AE risks in RCTs were only specifically addressed in a few previous systematic reviews (11, 12).”
From Risk of Death and Adverse Effects in Patients on Liothyronine: A Multisource Systematic Review and Meta-analysis (2025) · cites this paper as [11]
Millan-Alanis et al described adverse events in randomized controlled trials without a formal meta-analysis and concluded that overall incidence of adverse events in the 2 arms did not differ.
“One study by Millan-Alanis et al, which described AEs in RCTs without a formal meta-analysis, concluded that overall incidence of AEs in the 2 arms did not differ (11).”
From Risk of Death and Adverse Effects in Patients on Liothyronine: A Multisource Systematic Review and Meta-analysis (2025) · cites this paper as [11]
Patients with hypothyroidism prefer LT4+LT3 therapy over LT4 alone.
“Randomized clinical trials including all types of patients with hypothyroidism revealed that combination levothyroxine and liothyronine (LT4+LT3) therapy is safe and is the preferred choice of patients versus LT4 alone.”
From Emerging Therapies in Hypothyroidism (2024) · cites this paper as [16]
The present analyses performed a sensitivity analysis with the funnel plot to identify and eliminate RCTs contributing to elevated heterogeneity, an approach not followed in previous meta-analyses.
“Throughout the present analyses, we performed a sensitivity analysis with the funnel plot to identify and eliminate RCTs that contributed to an elevated heterogeneity (without affecting the robust preference for L-T4 + L-T3 and DTE), an approach that was not followed in the previous meta-analyses (7,8,32).”
From Treatment Preferences in Patients With Hypothyroidism (2025) · cites this paper as [8]
Two previous meta-analyses included nonrandomized trials (quasi-experimental), potentially compromising the quality of the assessment.
“Moreover, 2 previous meta-analyses (7, 8) included nonrandomized trials (quasi-experimental), potentially compromising the quality of the assessment.”
From Treatment Preferences in Patients With Hypothyroidism (2025) · cites this paper as [8]
Millan-Alanis et al identified a higher preference for combination therapy, with 43% of participants favoring it compared to 23% for monotherapy and 30% showing no preference.
“Similarly, Millan-Alanis et al (8) identified a higher preference for combination therapy, with 43% of participants favoring it compared to 23% for monotherapy and 30% showing no preference.”
From Treatment Preferences in Patients With Hypothyroidism (2025) · cites this paper as [8]
The study considered 5 additional RCTs not considered by Akirov et al, 5 additional RCTs not considered by the Millan-Alanis meta-analysis, and 4 additional RCTs not considered by Lan.
“We considered 5 additional RCTs not considered by Akirov et al (32), 5 additional RCTs not considered by the Millan-Alanis meta-analysis (8), and 4 additional RCTs not considered by Lan (7).”
From Treatment Preferences in Patients With Hypothyroidism (2025) · cites this paper as [8]
Millan-Alanis et al and Lan et al included one quasi-randomized study, and Lan et al also included 3 nonrandomized studies.
“Millan-Alanis et al and Lan et al included one quasi-randomized study, and the latter also included 3 nonrandomized studies.”
From Treatment Preferences in Patients With Hypothyroidism (2025) · cites this paper as [8]
Neither Millan-Alanis et al nor Lan et al used funnel plots to reduce heterogeneity when treatment preference was evaluated.
“Neither used funnel plots to reduce heterogeneity when treatment preference was evaluated.”
From Treatment Preferences in Patients With Hypothyroidism (2025) · cites this paper as [8]
Trials do not show a benefit from thyroid hormone replacement in persistent subclinical hypothyroidism.
“or to those with persistent subclinical hypothyroidism, where trials do not show a benefit from thyroid hormone replacement. 12,15,16,44 -46”
From Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement (2023) · cites this paper as [12]
The Conclusion (page unavailable) compares LT4/LT3 combination therapy with LT4 monotherapy in adults with hypothyroidism; it does not compare thyroid hormone replacement with no treatment in persistent subclinical hypothyroidism. A search for persistent subclinical hypothyroidism and replacement-versus-placebo trials found no passage addressing that claim. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThree previous meta-analyses evaluated patient preference with conflicting results.
“Three previous metanalyses evaluated patient preference as reported in those RCTs comparing L-T4 vs L-T4 + L-T3, with conflicting results.”
From Treatment Preferences in Patients With Hypothyroidism (2025) · cites this paper as [8]
The Discussion (page unavailable) mentions a previous meta-analysis on the topic, and the Results report this paper’s own analysis of patient preference. Neither passage establishes that three previous meta-analyses evaluated preference or that their results conflicted; searches for those points found no supporting passage in our copy. (LLM, conf=0.72)
Experimental — accuracy not yet measuredThe meta-analysis showed that the number of patients who withdrew from treatment for AE reminiscent of thyrotoxicosis was about half the number who withdrew for symptoms reminiscent of unaddressed hypothyroidism (18 vs. 32).
“This analysis also showed that the number of patients within included studies who withdrew from treatment for AE reminiscent of thyrotoxicosis was about half the number who withdrew for symptoms reminiscent of unaddressed hypothyroidism (18 vs. 32).”
From A review of the safety of triiodothyronine in combination with levothyroxine for the management of hypothyroidism (2024) · cites this paper as [54]
Evidence of low-to-moderate certainty derived from standardized questionnaires did not suggest differences between therapies with regard to clinical status, quality of life, psychological distress, depressive symptoms, or fatigue.
“Evidence of low-to-moderate certainty derived from standardized questionnaires did not suggest differences between therapies with regard to clinical status, quality of life, psychological distress, depressive symptoms, or fatigue.”
From A review of the safety of triiodothyronine in combination with levothyroxine for the management of hypothyroidism (2024) · cites this paper as [54]
A recent meta-analysis stated that overall incidence of adverse events with combined therapy did not appear to differ when compared with monotherapy.
“A recent meta-analysis supported these conclusions, stating that”
From A review of the safety of triiodothyronine in combination with levothyroxine for the management of hypothyroidism (2024) · cites this paper as [54]
Randomized controlled trials have not established greater efficacy for the LT3 + LT4 combination than for LT4 alone in hypothyroid subjects dissatisfied with LT4.
“However, randomized controlled trials (RCT), have not established greater efficacy for the LT3 + LT4 combination in these subjects than for LT4 alone.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Cochrane Handbook for Systematic Reviews of Interventions
(2019) · doi:10.1002/9781119536604 · Cited by 14,828 · 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
Saravanan, P., Chau, W. ‐., Roberts, N., Vedhara, K., Greenwood, R., & Dayan, C. M. (2002) · Clinical Endocrinology · doi:10.1046/j.1365-2265.2002.01654.x · Cited by 514 · see citing works
Interpreting estimates of treatment effects: implications for managed care.
(2008) · PubMed Central · Cited by 511 · see citing works
Bunevičius, R., Kažanavičius, G., Žalinkevičius, R., & Prange, A. J. (1999) · New England Journal of Medicine · doi:10.1056/nejm199902113400603 · Cited by 482 · see citing works
2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism
Wiersinga, W. M., Duntas, L., Fadeyev, V., Nygaard, B., & Vanderpump, M. P. J. (2012) · European Thyroid Journal · doi:10.1159/000339444 · Cited by 427 · cited 1× · see citing works
“Consequently, by 2012, the European Thyroid Association (ETA) guidelines stated that LT4/LT3 combined therapy could be used as an experimental therapy in some LT4-treated patients with persistent hypothyroidism-related symptoms despite normalized thyroid hormone levels (21).”
Panicker, V., Saravanan, P., Vaidya, B., Evans, J., Hattersley, A. T., Frayling, T. M., & Dayan, C. M. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-1301 · Cited by 327 · see citing works
Wekking, E. M., Appelhof, B. C., Fliers, E., Schene, A. H., Huyser, J., Tijssen, J. G. P., & Wiersinga, W. M. (2005) · European Journal of Endocrinology · doi:10.1530/eje.1.02025 · Cited by 299 · see citing works
Grozinsky-Glasberg, S., Fraser, A., Nahshoni, E., Weizman, A., & Leibovici, L. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2006-0448 · Cited by 296 · see citing works
Escobar-Morreale, H. F., del Rey, F. E., Obregón, M. J., & de Escobar, G. M. (1996) · Endocrinology · doi:10.1210/endo.137.6.8641203 · Cited by 261 · see citing works
An Online Survey of Hypothyroid Patients Demonstrates Prominent Dissatisfaction
Peterson, S. J., Cappola, A. R., Castro, M. R., Dayan, C. M., Farwell, A. P., Hennessey, J. V., Kopp, P. A., Ross, D. S., Samuels, M. H., Sawka, A. M., et al. (2018) · Thyroid · doi:10.1089/thy.2017.0681 · Cited by 231 · see citing works
Walsh, J. P., Shiels, L., Lim, E. M., Bhagat, C. I., Ward, L. C., Stuckey, B. G. A., Dhaliwal, S. S., Chew, G. T., Bhagat, M. C., & Cussons, A. J. (2003) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2003-030249 · Cited by 210 · see citing works
Clyde, P. W., Harari, A. E., Getka, E. J., & Shakir, K. M. M. (2003) · JAMA · doi:10.1001/jama.290.22.2952 · Cited by 195 · see citing works
Appelhof, B. C., Fliers, E., Wekking, E. M., Schene, A. H., Huyser, J., Tijssen, J. G. P., Endert, E., van Weert, H. C. P. M., & Wiersinga, W. M. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-2111 · Cited by 183 · see citing works
Escobar-Morreale, H. F., Botella-Carretero, J. I., Gómez-Bueno, M., Galán, J. M., Barrios, V., & Sancho, J. (2005) · Annals of Internal Medicine · doi:10.7326/0003-4819-142-6-200503150-00007 · Cited by 182 · see citing works
Is a Normal TSH Synonymous With “Euthyroidism” in Levothyroxine Monotherapy?
Peterson, S. J., McAninch, E. A., & Bianco, A. C. (2016) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2016-2660 · Cited by 182 · see citing works
Sawka, A. M., Gerstein, H. C., Marriott, M. J., MacQueen, G. M., & Joffe, R. T. (2003) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2003-030139 · Cited by 175 · see citing works
Jonklaas, J., Bianco, A. C., Cappola, A. R., Celi, F. S., Fliers, E., Heuer, H., McAninch, E. A., Moeller, L. C., Nygaard, B., Sawka, A. M., et al. (2021) · Thyroid® · doi:10.1089/thy.2020.0720 · Cited by 172 · cited 6× · see citing works
“Selecting an appropriate patient population for combined therapy in the setting of an adequately powered study would be a crucial step in the performance of new clinical trials on the topic (45,46).”
InfluentialTreatment of Hypothyroidism with Combinations of Levothyroxine plus Liothyronine
Escobar-Morreale, H. F., Botella-Carretero, J. I., del Rey, F. E., & de Escobar, G. M. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-0184 · Cited by 160 · cited 2× · see citing works
“From 2000 to 2009, several clinical trials and a meta-analysis compared LT4/LT3 combined with LT4 monotherapy without evidence of superiority of any treatment modality (2,5,16,17–20).”
Nygaard, B., Jensen, E. W., Kvetny, J., Jarløv, A., & Faber, J. (2009) · European Journal of Endocrinology · doi:10.1530/eje-09-0542 · Cited by 153 · see citing works
Siegmund, W., Spieker, K., Weike, A. I., Giessmann, T., Modess, C., Dabers, T., Kirsch, G., Sänger, E., Engel, G., Hamm, A. O., et al. (2004) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2004.02050.x · Cited by 152 · see citing works
Hoang, T. D., Olsen, C. H., Mai, V. Q., Clyde, P. W., & Shakir, M. K. M. (2013) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2012-4107 · Cited by 151 · see citing works
Saravanan, P., Simmons, D. J., Greenwood, R., Peters, T. J., & Dayan, C. M. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-1672 · Cited by 136 · see citing works
Panicker, V., Evans, J., Bjøro, T., Åsvold, B. O., Dayan, C. M., & Bjerkeset, O. (2009) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2008.03521.x · Cited by 121 · see citing works
The history and future of treatment of hypothyroidism
McAninch, E. A., & Bianco, A. C. (2016) · Annals of Internal Medicine · doi:10.7326/m15-1799 · Cited by 118 · see citing works
Slawik, M., Klawitter, B., Meiser, E., Schories, M., Zwermann, O., Borm, K., Peper, M., Lubrich, B., Hug, M. J., Nauck, M., et al. (2007) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2007-0297 · Cited by 113 · see citing works
Bunevicius, R., Jakubonien, N., Jurkevicius, R., Cernicat, J., Lašas, L., & Prange, A. J. (2002) · Endocrine · doi:10.1385/endo:18:2:129 · Cited by 111 · see citing works
Thyroxine alone or thyroxine plus triiodothyronine replacement therapy for hypothyroidism
Chao, M., Jiawei, X., Xia, H., Guoming, W., Yangang, W., Xufu, W., & Shuyao, Z. (2009) · Nuclear Medicine Communications · doi:10.1097/mnm.0b013e32832c79e0 · Cited by 93 · see citing works
Carlé, A., Faber, J., Steffensen, R., Laurberg, P., & Nygaard, B. (2017) · European Thyroid Journal · doi:10.1159/000469709 · Cited by 93 · see citing works
Rodriguez, T., Lavis, V. R., Meininger, J. C., Kapadia, A. S., & Stafford, L. F. (2005) · Endocrine Practice · doi:10.4158/ep.11.4.223 · Cited by 80 · see citing works
Bunevičius, R., & Prange, A. J. (2000) · The International Journal of Neuropsychopharmacology · doi:10.1017/s1461145700001826 · Cited by 78 · see citing works
Fadeyev, V. V., Morgunova, T. B., Melnichenko, G. A., & Dedov, I. I. (2010) · Hormones · doi:10.14310/horm.2002.1274 · Cited by 77 · see citing works
Valizadeh, M., Seyyed-Majidi, M. R., Hajibeigloo, H., Momtazi, S., Musavinasab, N., & Hayatbakhsh, M. R. (2009) · Endocrine Research · doi:10.1080/07435800903156340 · Cited by 65 · see citing works
Joffe, R. T., Brimacombe, M., Levitt, A. J., & Stagnaro-Green, A. (2007) · Psychosomatics · doi:10.1176/appi.psy.48.5.379 · Cited by 57 · see citing works
Thyroid Hormone Use: Trends in the United States from 1960 Through 1988
Kaufman, S. C., Gross, T. P., & Kennedy, D. L. (1991) · Thyroid · doi:10.1089/thy.1991.1.285 · Cited by 45 · see citing works
Kaminski, J., Miasaki, F. Y., Paz-Filho, G., Graf, H., & Carvalho, G. A. D. (2016) · Archives of Endocrinology and Metabolism · doi:10.1590/2359-3997000000192 · Cited by 42 · see citing works
Jonklaas, J., & Burman, K. D. (2016) · Thyroid® · doi:10.1089/thy.2015.0629 · Cited by 41 · see citing works
Akirov, A., Fazelzad, R., Ezzat, S., Thabane, L., & Sawka, A. M. (2019) · Frontiers in Endocrinology · doi:10.3389/fendo.2019.00477 · Cited by 37 · see citing works
T4 + T3 combination therapy: any progress?
Wiersinga, W. M. (2019) · Endocrine · doi:10.1007/s12020-019-02052-2 · Cited by 35 · see citing works
Prescribing Therapy for Hypothyroidism: Influence of Physician Characteristics
Jonklaas, J., Tefera, E., & Shara, N. (2019) · Thyroid · doi:10.1089/thy.2018.0369 · Cited by 31 · see citing works
Pharmacokinetics of L-Triiodothyronine in Patients Undergoing Thyroid Hormone Therapy Withdrawal
Van Tassell, B., Wohlford, G. F., Linderman, J. D., Smith, S., Yavuz, S., Pucino, F., & Celi, F. S. (2019) · Thyroid® · doi:10.1089/thy.2019.0101 · Cited by 31 · see citing works
Medici, B. B., la Cour, J. L., Michaelsson, L. F., Faber, J. O., & Nygaard, B. (2017) · European Thyroid Journal · doi:10.1159/000454878 · Cited by 25 · see citing works
The Swinging Pendulum in Treatment for Hypothyroidism: From (and Toward?) Combination Therapy
McAninch, E. A., & Bianco, A. C. (2019) · Frontiers in Endocrinology · doi:10.3389/fendo.2019.00446 · Cited by 24 · see citing works
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
Self-citationHoermann, R., Midgley, J. E. M., Larisch, R., & Dietrich, J. W. (2018) · Journal of Thyroid Research · doi:10.1155/2018/3239197 · Cited by 20 · see citing works
Krysiak, R. G., Szkróbka, W., & Okopień, B. (2018) · Current Medical Research and Opinion · doi:10.1080/03007995.2018.1448771 · Cited by 17 · see citing works
LT4 and Slow Release T3 Combination: Optimum Therapy for Hypothyroidism?
Azizi, F., Amouzegar, A., Mehran, L., & Abdi, H. (2020) · Intern J Endocrinol Metab · doi:10.5812/ijem.100870 · Cited by 11 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [42]42. Escobar-Morreale H F, Del-Rey, EF, Obregon, MJ, de Escobar, GM (1996). Only the combined treatment in all tissues the thyroidectomized by passing this aqueous phase through. Endocrinology 137:2490–2502. [DOI] [PubMed] [Google Scholar]
Cited by
Sorted by citations
Chaker, L., Razvi, S., Bensenor, I. M., Azizi, F., Pearce, E. N., & Peeters, R. P. (2022) · Nature Reviews Disease Primers · doi:10.1038/s41572-022-00357-7 · Cited by 330 · see citing works
Ovčariček, P. P., Görges, R., & Giovanella, L. (2023) · Seminars in Nuclear Medicine · doi:10.1053/j.semnuclmed.2023.11.002 · Cited by 80 · see citing works
Brain Fog in Hypothyroidism: What Is It, How Is It Measured, and What Can Be Done About It
Samuels, M. H., & Bernstein, L. J. (2022) · Thyroid · doi:10.1089/thy.2022.0139 · Cited by 55 · see citing works
Emerging Therapies in Hypothyroidism
Bianco, A. C. (2024) · Annual Review of Medicine · doi:10.1146/annurev-med-060622-101007 · Cited by 36 · see citing works
Ahluwalia, R., Baldeweg, S. E., Boelaert, K., Chatterjee, K., Dayan, C., Okosieme, O., Priestley, J., Taylor, P., Vaidya, B., Zammitt, N., et al. (2023) · Clinical Endocrinology · doi:10.1111/cen.14935 · Cited by 34 · see citing works
“42 12, 42, 43 Almost all these blinded RCTs At present in the United Kingdom, there is a 49 ‐ fold variation in the number of liothyronine prescriptions per 1000 levothyroxine prescriptions by local prescribing region.”
BackgroundLan, H., Wen, J., Mao, Y., Huang, H., Chen, G., & Lin, W. (2022) · Clinical Endocrinology · doi:10.1111/cen.14742 · Cited by 26 · see citing works
Critical Approach to Hypothyroid Patients With Persistent Symptoms
Biondi, B., Celi, F. S., & McAninch, E. A. (2023) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgad224 · Cited by 28 · see citing works
Thyroid Hormone Abuse in Elite Sports: The Regulatory Challenge
Gild, M. L., Stuart, M. C., Clifton-Bligh, R. J., Kinahan, A., & Handelsman, D. J. (2022) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgac223 · Cited by 26 · see citing works
Casula, S., Ettleson, M. D., & Bianco, A. C. (2023) · Endocrine Practice · doi:10.1016/j.eprac.2023.04.003 · Cited by 18 · see citing works
Treatment Preferences in Patients With Hypothyroidism
de Lima Beltrão, F. E., Carvalhal, G., de Almeida Beltrão, D. C., de Lima Beltrão, F. E., Ribeiro, M. O., Ettleson, M. D., Ramos, H. E., & Bianco, A. C. (2025) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgae651 · Cited by 15 · see citing works
Biondi, B., Pucci, M., Pontieri, G., Formisano, P., & Esposito, R. (2023) · Thyroid · doi:10.1089/thy.2023.0135 · Cited by 15 · see citing works
Molewijk, E., Fliers, E., Dreijerink, K. M. A., van Dooren, A. A., & Heerdink, E. R. (2024) · Journal of Clinical & Translational Endocrinology · doi:10.1016/j.jcte.2024.100330 · Cited by 18 · see citing works
Jonklaas, J. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.934003 · Cited by 12 · see citing works
Bahl, S., Taylor, P. N., Premawardhana, L. D., Stedman, M., Heald, A., Dayan, C. M., & Okosieme, O. E. (2025) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaf449 · Cited by 11 · see citing works
“Systematic reviews on LT3 safety are limited and have been confined to the analyses of short-term adverse outcomes in treatment efficacy trials (11, 12).”
InfluentialNassar, M., Hassan, A., Ramadan, S., Desouki, M. T., Hassan, M. A., & Chaudhuri, A. (2024) · BMC Endocrine Disorders · doi:10.1186/s12902-024-01612-6 · Cited by 12 · see citing works
“Despite mixed results in clinical trials, patient preference for combined therapy over T4 alone often arises from subjective improvements in symptoms like fatigue and cognitive function, which are not consistently quantifiable by standard clinical parameters [31].”
BackgroundAttanasio, R., Žarković, M., Papini, E., Nagy, E. V., Negro, R., Perros, P., Akarsu, E., Alevizaki, M., Ayvaz, G., Bednarczuk, T., et al. (2024) · Thyroid® · doi:10.1089/thy.2023.0580 · Cited by 11 · see citing works
Xu, Y., Wang, C., Li, X., Guo, W.-L., Liu, G., Zhang, H., Sun, Y., Zhu, D.-F., & Xu, Q. (2022) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2022.113495 · Cited by 11 · see citing works
Triiodothyronine alongside levothyroxine in the management of hypothyroidism?
Gottwald-Hostalek, U., & Kahaly, G. J. (2021) · Current Medical Research and Opinion · doi:10.1080/03007995.2021.1984219 · Cited by 9 · see citing works
Iglesias, P. (2025) · Endocrine Practice · doi:10.1016/j.eprac.2025.02.004 · Cited by 8 · see citing works
Practical and Pragmatic Usage of T3 in Hypothyroidism
Kalra, S., Dhingra, A., Kapoor, N., & Sahay, R. K. (2023) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/ijem.ijem_441_22 · Cited by 8 · see citing works
Penna, G. C., Bianco, A. C., & Ettleson, M. D. (2024) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgad629 · Cited by 8 · see citing works
Gottwald-Hostalek, U., & Tayrouz, Y. (2024) · Current Medical Research and Opinion · doi:10.1080/03007995.2024.2435460 · Cited by 6 · see citing works
Premawardhana, L. D., Taylor, P. N., Okosieme, O. E., Adlan, M. A., Obuobie, E. K., & Dayan, C. M. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1282608 · Cited by 6 · see citing works
Guglielmi, R., Mian, C., Novizio, R., Paoletta, A., Persichetti, A., Samperi, I., Scoppola, A., Bagnasco, M., Menis, E. D., Rimini, M. L. D., et al. (2025) · Journal of Endocrinological Investigation · doi:10.1007/s40618-025-02652-y · Cited by 6 · see citing works
Shared Decisionmaking in the Treatment of Hypothyroidism
Bianco, A. C. (2025) · Clinical Endocrinology · doi:10.1111/cen.15228 · Cited by 5 · see citing works
Prevalence and severity of fatigue in treated hypothyroidism: results of a UK survey
Grixti, L., Fisher, H., Priestley, J., McMullan, C., Woollven, A., Perros, P., Mitchell, A. L., Gan, E. H., & Pearce, S. H. S. (2025) · European Thyroid Journal · doi:10.1530/etj-25-0044 · Cited by 5 · see citing works
Braafladt, S. M., Allison, H. R., Chung, J. W., Mariash, C. N., Bhattacharyya, O., McDow, A. D., & Haggstrom, D. A. (2024) · Surgery · doi:10.1016/j.surg.2024.07.057 · Cited by 5 · see citing works
More trials for the unhappy hypothyroid patient on thyroxine: a clinician’s perspective
Welborn, T. A. (2022) · Trends in Endocrinology and Metabolism · doi:10.1016/j.tem.2022.04.010 · Cited by 5 · see citing works
Hedberg, F., Lindh, J. D., Mannheimer, B., Planck, T., Skov, J., Lehtihet, M., Falhammar, H., & Calissendorff, J. (2025) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaf337 · Cited by 2 · see citing works
Sim, M., Tan, E., Liew, H., Tan, A. W. K., & Li, H. (2025) · Journal of Surgical Research · doi:10.1016/j.jss.2025.10.041 · Cited by 2 · see citing works
Caron, P. J. (2023) · Annales d Endocrinologie · doi:10.1016/j.ando.2023.05.005 · Cited by 2 · see citing works
Thyroid hormone use in clinical practice by Israeli endocrinologists: a THESIS* questionnaire survey
Sasson, L., Kaminer, K., Cohen, C. A., Hegedűs, L. D., Negro, R., Nagy, E. V., Papini, E., Perros, P., Attanasio, R., & Robenshtok, E. (2025) · Thyroid Research · doi:10.1186/s13044-024-00219-2 · Cited by 2 · see citing works
Jonklaas, J. (2025) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2025.2492789 · Cited by 2 · see citing works
Phase 1 Clinical Trial of Poly-Zinc-Liothyronine Demonstrates Slow-Release Serum T 3 Kinetics
McAninch, E. A. (2022) · Clinical Thyroidology · doi:10.1089/ct.2022;34.9-12 · Cited by 2 · see citing works
Albassam, M. M., Obaid, N. M., & Al-Zwaini, Y. K. H. (2024) · Baghdad Journal of Biochemistry and Applied Biological Sciences · doi:10.47419/bjbabs.v5i03.285 · Cited by 1 · see citing works
Role of T3 in Management of Hypothyroidism
Kalra, S., Mithal, A., WANGNOO, S. K., Seshadri, K., & Dharmalingnam, M. (2025) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/ijem.ijem_294_24 · Cited by 2 · see citing works
Hedberg, F., Lindh, J. D., Mannheimer, B., Planck, T., Skov, J., Falhammar, H., & Calissendorff, J. (2026) · Journal of the Endocrine Society · doi:10.1210/jendso/bvag107 · Cited by 1 · see citing works
Bartalena, L., Gallo, D., Piantanida, E., & Tanda, M. L. (2026) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2026.2676876 · Cited by 1 · see citing works
Quality of life in hypothyroid subjects treated with levothyroxine: a cross-sectional study
Rezaeizade, H., Shabestari, M., Hazar, N., Ghadiri‐Anari, A., Mehrali, M., Salehi‐Shadkami, M., & Azizi, R. (2026) · Thyroid Research · doi:10.1186/s13044-026-00307-5 · Cited by 1 · see citing works
EndoBridge 2025: pearls and highlights
Yıldız, B. O., Armenti, M., Brandi, M. L., Carey, J., Carling, T., Ciudin, A., Dhatariya, K., Fountas, A., Frühbeck, G., Goulis, D., et al. (2026) · HORMONES · doi:10.1007/s42000-026-00804-0 · Cited by 1 · see citing works
Hypothyroidism: A Small Clinical Trial Will Quickly Resolve the Combination Therapy Controversy
Welborn, T. A., & Dhaliwal, S. S. (2022) · International Journal of Clinical Biostatistics and Biometrics · doi:10.23937/2469-5831/1510049 · Cited by 1 · see citing works
Combined LT3 and LT4 therapy for precision medicine: easier with TTCombo system
Gatta, E., Ippolito, S., & Cappelli, C. (2024) · Endocrine · doi:10.1007/s12020-024-04084-9 · Cited by 1 · see citing works
Shakir, M. K. M., Brooks, D. I., McAninch, E. A., Fonseca, T. D. L., Mai, V. Q., Bianco, A. C., & Hoang, T. D. (2021) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgab779
Ahmadi, S. (2024) · Clinical Thyroidology · doi:10.1089/ct.2024;36.47-50
T3 in 2023: LT3 + LT4 combination therapy for primary hypothyroidism
Sethi, B. K., Dukle, V., Inamadar, S. S., & Sonwane, A. C. (2024) · Thyroid Research and Practice · doi:10.4103/trp.trp_30_23
Hypothyroïdie : diagnostic et suivi chez l’adulte
Guibourdenche, J., Leguy, M.-C., & Bonnet-Serrano, F. (2024) · Revue Francophone des Laboratoires · doi:10.1016/s1773-035x(24)00304-6
Patients Prefer T3-Containing Therapies for Hypothyroidism
McAninch, E. A. (2024) · Clinical Thyroidology · doi:10.1089/ct.2024;36.431-433
Hoermann, R., & Dietrich, J. W. (2025) · Springer eBooks · doi:10.1007/978-981-96-3682-2_11
Precision Thyroid Hormone Therapy for Hypothyroidism
Bianco, A. C., & Beltrão, F. E. D. L. (2025) · Springer eBooks · doi:10.1007/978-3-031-89650-7_24
Vélez-Pérez, R. D. F., Arias‐Borrego, A., Velasco, I., Soldevila, B., & García‐Barrera, T. (2025) · Food Chemistry · doi:10.1016/j.foodchem.2025.145542
Safe Optimization of Thyroid Hormone Therapy
Jonklaas, J. (2025) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaf512
Nassar, M., Hassan, A., Ramadan, S., Desouki, M., Hassan, M. A., & Chaudhuri, A. (2024) · Figshare · doi:10.6084/m9.figshare.26733783
Геннадьевна, Р. Е., Моргунова, Т. Б., Ryzhkov, I., & Fadeyev, V. (2026) · Vrach · doi:10.29296/25877305-2026-05-13
Nagayama, Y., Tachibana, S., Fukuda, T., Tatsushima, D., Mori, Y., Shindo, H., Takahashi, H., Satoh, S., Nakashima, M., & Yamashita, H. (2026) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgag220
The Safety of Liothyronine: “First, Do No Harm”
Costa, D. N., & Mammen, J. S. (2026) · Clinical Thyroidology · doi:10.1177/23299711261420490
Yoon, J. H., Shin, D. Y., Kim, H. K., Attanasio, R., Papini, E., Perros, P., Nagy, E. V., Hegedűs, L. D., Kim, S. W., & Kang, H. (2026) · Endocrinology and Metabolism · doi:10.3803/enm.2025.2868
Wu, W., Sun, Z., Liu, M., Huang, Y., Liu, T., Qiu, X., & Wang, Y. (2026) · Frontiers in Pediatrics · doi:10.3389/fped.2026.1908940
Hashimoto's thyroiditis: two decades on
Duntas, L. H., & Effraimidis, G. (2026) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(26)00189-0
- Authors
- Millan-Alanis, J. M., González-González, J. G., Flores-Rodríguez, A., Singh Ospina, N., Maraka, S., Moreno-Peña, P. J., Brito, J. P., González-Velázquez, C., & Rodríguez-Gutiérrez, R.
- Affiliations
- Plataforma INVEST Medicina UANL KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México.
- Mayo Clinic (US)
- Division of Endocrinology, University of Florida, Gainesville, Florida, USA.
- Endocrinology Division, Department of Internal Medicine, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, México.
- ORCID
- Venue
- Thyroid®
- Publisher
- SAGE Publications
- Published
- 2021-11
- Volume
- 31
- Issue
- 11
- Pages
- 1613-1625
- ISSN
- 1050-7256 (ISSN-L)
- 1557-9077
- PMC
- PMC8917901
- OpenAlex
- W3191235977
- Cited by
- 60
- References
- 48
- Citations by year
- 2026: 10 · 2025: 14 · 2024: 13 · 2023: 11 · 2022: 10 · 2021: 2
- FWCI
- 1.38
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Thyroid (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (K08CA248972)
- 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 › Thyroid Cancer Diagnosis and Treatment
- Keywords
- hypothyroidism, levothyroxine, triiodothyronine, levothyroxine monotherapy, patient preferences, quality of life, depressive symptoms, fatigue, psychological distress, adverse events, shared decision-making
- MeSH terms
- Adult, Drug Therapy, Combination, Humans, Hypothyroidism, Thyroxine, Triiodothyronine
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
