Is there a role for natural desiccated thyroid in the treatment of levothyroxine unresponsive hypothyroidism? Results from a consecutive case series
Open accessAbstract
INTRODUCTION: . These contain a mixture of levothyroxine and liothyronine in a fixed ratio. We evaluated the response to NDT in individuals at a single endocrine centre in terms of how the change from levothyroxine to NDT impacted on their lives in relation to quality of life (QOL) and thyroid symptoms. METHODS: The ThyPRO39 (thyroid symptomatology) and EQ-5D-5L-related QoL/EQ5D5L (generic QOL) questionnaires were administered to 31 consecutive patients who had been initiated on NDT, before initiating treatment/6 months later. RESULTS: There were 28 women and 3 men. The dose range of NDT was 60-180 mg daily. Age range was 26-77 years with length of time since diagnosis with hypothyroidism ranging from 2 to 40 years. One person discontinued the NDT because of lack of response; two because of cardiac symptoms. EQ-5D-5L utility increased from a mean (SD) of 0.214 (0.338) at baseline, to 0.606 (0.248) after 6 months; corresponding to a difference of 0.392 (95% CI 0.241-0.542), t = 6.82, P < .001. EQ-VAS scores increased from 33.4 (17.2) to 71.1 (17.5), a difference of 37.7 (95% CI 25.2-50.2), t = -4.9, P < .001. ThyPRO scores showed consistent fall across all domains with the composite QoL-impact Score improving from 68.3 (95% CI 60.9-75.7) to 25.2 (95% CI 18.7-31.7), a difference of 43.1 (95% CI 33-53.2) (t = 5.6, P < .001). CONCLUSION: Significant symptomatic benefit and improvement in QOL was experienced by people with a history of levothyroxine unresponsive hypothyroidism treated with NDT, suggesting the need for further evaluation of NDT in this context.
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Many patients who do not fully benefit from LT4 experience improved quality of life and cognition after switching to LT4+LT3.
“Many patients who do not fully benefit from LT4 experience improved quality of life and cognition after switching to LT4+LT3.”
From Emerging Therapies in Hypothyroidism (2024) · cites this paper as [49]
The Abstract (p. 2) reports improved quality-of-life scores after 31 levothyroxine-unresponsive patients switched to natural desiccated thyroid (NDT), which contains LT4 and LT3. But the study evaluated NDT rather than a separately prescribed LT4+LT3 regimen, and it does not report improved cognition. The Discussion (approximately p. 11) instead notes that a cited trial found no difference in neurocognitive measurements between NDT and levothyroxine. (LLM, conf=0.89)
Experimental — accuracy not yet measuredAn open-label study of consecutive symptomatic LT4-treated patients supported the benefits of combination therapy.
“An open-label study of consecutive symptomatic LT4-treated patients supported the benefits of combination therapy (49).”
From Emerging Therapies in Hypothyroidism (2024) · cites this paper as [49]
The Results and Conclusion (pp. 3, 14) report symptomatic and quality-of-life improvements after natural desiccated thyroid (NDT) in people unresponsive to levothyroxine, while acknowledging that the study was unblinded and had no comparator. The Introduction (p. 5) distinguishes NDT from levothyroxine/liothyronine combination therapy, so the findings support a potential benefit of NDT, not combination therapy generally. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThe majority of patients in the case series found their symptoms to be alleviated.
“The authors noted that the majority of patients found these symptoms to be alleviated and suggested that this could be viewed as robust evidence for the potential benefit of NDT.”
From Natural desiccated thyroid for the treatment of hypothyroidism? (2024) · cites this paper as [16]
The Discussion and Conclusion say that the majority of patients found their symptoms alleviated. They describe this as supportive evidence for a potential benefit of NDT, not robust evidence; the Strengths and limitations section also emphasizes the lack of a comparator group or blinding and the possibility of a placebo effect. (LLM, conf=0.90)
Experimental — accuracy not yet measuredIn the authors' recent case series, significant benefit was experienced by people who were treated with NDT because of their lack of response to levothyroxine.
“In our recent case series (16) it was reported that significant benefit was experienced by people who by nature of their lack or response to levothyroxine were treated with NDT.”
From Natural desiccated thyroid for the treatment of hypothyroidism? (2024) · cites this paper as [16]
Significant benefit is experienced by people who, by nature of their lack of response to levothyroxine, have been treated with NDT.
“Significant benefit is experienced by people who by nature of their lack or response to levothyroxine have been treated with NDT.”
From Natural desiccated thyroid for the treatment of hypothyroidism? (2024) · cites this paper as [16]
Animal-derived DTE has been introduced to treat refractory hypothyroidism due to combinations of T3 and T4 in a 1:4.22 ratio.
“Animal-derived DTE has also been introduced to treat refractory hypothyroidism due to combinations of T3 and T4 in a 1:4.22 ratio (155).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [155]
Animal-derived DTE contains a supraphysiological amount of T3.
“Animal-derived DTE contains a supraphysiological amount of T3, and cardiac complications should be monitored with caution.”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [155]
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Self-citation
- Authors
- Heald, A. H., Premawardhana, L., Taylor, P., Okosieme, O., Bangi, T., Devine, H., Livingston, M., Javed, A., Moreno, G. Y. C., Watt, T., Stedman, M., Dayan, C., & Hughes, D. A.
- Affiliations
- Manchester Academic Health Science Centre (GB)
- Cardiff University (GB)
- Salford Royal NHS Foundation Trust (GB)
- Walsall Manor Hospital (GB)
- Coordinación Nacional de Investigación Subdirección de Servicios de Salud, Petróleos Mexicanos Ciudad de México México
- Herlev Hospital (DK)
- Res Consortium Andover UK
- Bangor University (GB)
- Corresponding author
- Heald, Adrian H.
- ORCID
- Venue
- International Journal of Clinical Practice
- Publisher
- Hindawi Limited
- Published
- 2021-11-20
- Volume
- 75
- Issue
- 12
- Pages
- e14967-e14967
- ISSN
- 1368-5031 (ISSN-L)
- 1742-1241
- OpenAlex
- W3207216775
- Cited by
- 14
- References
- 21
- Citations by year
- 2025: 2 · 2024: 5 · 2023: 3 · 2022: 4
- FWCI
- 2.24
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- International Journal of Clinical Practice (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
- University of Birmingham Research Portal (University of Birmingham) (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- Bangor University Research Portal (Bangor University) (submittedVersion, other-oa)
- 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, quality of life, thyroid symptoms, liothyronine, thyroid hormone replacement, EQ-5D-5L, treatment response, cardiac side effects, dose adjustment, patient-reported outcomes, cost-effectiveness
- MeSH terms
- Adult, Aged, Female, Humans, Hypothyroidism, Male, Middle Aged, Quality of Life, Thyroxine, Triiodothyronine
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