Check for updatesReceived:13 February 2023 Revised:18 May 2023Accepted:19 May 2023D0t10.1111/cen.14935GUIDELINESWILEYUse of liothyronine(T3)in hypothyroidism:Joint BritishThyroid Association/Society for endocrinology consensusstatementRupa Ahluwalia Stephanie E.Baldeweg23.4 Kristien Boelaert5Krishna Chatterjees Colin Dayan7 Onyebuchi Okosieme?Julia Priestley3 Peter Taylor?Bijay Vaidya Nicola Zammitt10Simon H.Pearce11Department of Diabetes&Endocrinology.Norfolk and Norwich University HospitalsAbstractNHS Trust Norwich.UKPersistent symptoms in patients treated for hypothyroidism are common.Despite2Department of Diabetes&Endocrinology.University College London,London.UKmore than 20 years of debate,the use of liothyronine for this indication remainsCentre for Obesity Metabolism.controversial,as numerous randomised trials have failed to show a benefit ofDepartment of Experimental Translationaltreatment regimens that combine liothyronine (T3)with levothyroxine overMedicine,Division of Medicine,UniversityCollege London Hospitals,London,UKlevothyroxine monotherapy.This consensus statement attempts to provide practicalThe RCP Joint Specialties Committee andguidance to clinicians faced with patients who have persistent symptoms duringThe Clinical Committee,Society forthyroid hormone replacement therapy.It applies to non-pregnant adults and isEndocrinology.Bristol,UK5Institute for Applied Health Research.focussed on care delivered within the UK National Health Service,although it mayCollege of Medical and Dental Scences,be relevant in other healthcare environments.University of Birmingham,Birmingham,UKThe statement emphasises several key clinical practice points for patientsWellcome-MRC Institute of MetabolicSciences,University of Cambridgedissatisfied with treatment for hypothyroidism.Firstly,it is important to establishCambridge,UKa diagnosis of overt hypothyroidism;patients with persistent symptoms during7Thyroid Research Group.Heath Park,Cardiffthyroid hormone replacement but with no clear biochemical evidence of overtUniversity.Cardiff,UKhypothyroidism should first have a trial without thyroid hormone replacement.InBritish Thyroid Foundation,Harrogate,UKDepartment of Endocrinology.Royal Devonthose with established overt hypothyroidism,levothyroxine doses should beUniversity Hospital |University of Exeteroptimised aiming for a TSH in the 0.3-2.0 mU/L range for 3 to 6 months before aMedical School,Exeter,UKtherapeutic response can be assessed.In some patients,it may be acceptable to have0Edinburgh Centre for Endocrinology andserum TSH below reference range (e.g.0.1-0.3 mU/L),but not fully suppressed inDiabetes,Royal Infirmary of Edinburgh,Edinburgh,UKthe long term.1BioMedicine West,Translational and ClinicalWe suggest that for some patients with confirmed overt hypothyroidism andResearch Institute,Newcastle University.Newcastle upon Tyne,UKpersistent symptoms who have had adequate treatment with levothyroxine and inwhom other comorbidities have been excl
