The effects of levothyroxine monotherapy versus combination therapy on quality of life and patient satisfaction.

INTRODUCTION: Hypothyroidism is a relatively common condition, which generally cannot be reversed. Hypothyroid individuals are dependent on provision of exogenous thyroid hormone as a lifetime therapy. Levothyroxine therapy provides satisfactory treatment for most. However, a subset of patients are not restored to their baseline quality of life.

AREAS COVERED: As discussed here, a number of solutions have been tried, including addressing accompanying conditions, rigorous titration of therapy, and combination therapy with levothyroxine and liothyronine. The latter has limited success with improving quality of life, but does appear to be associated with patient preference. The discrepancy between quality of life and patient preference may be important to understanding the nuances of successful hypothyroidism treatment.

EXPERT OPINION: Future efforts to improve hypothyroidism therapy could tease out which are the specific subset of patients who benefit from combination therapy, such as those who have unresolved symptoms attributable to hypothyroidism at baseline and those with genetic polymorphisms that might impair thyroid hormone delivery to tissues. Better understanding of the drivers of patient preference for combination therapy should also be revealing. A future goal is to prevent autoimmune hypothyroidism from developing and to treat hypothyroidism completely by generating fully functioning thyroid follicles from stem cells.