Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study.
J Clin Endocrinol Metab. 2013 May ;98(5):1982-90. Epub 2013 Mar 28. PMID: 23539727
Department of Endocrinology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, Maryland 20889-5600, USA.
CONTEXT: Patients previously treated with desiccated thyroid extract (DTE), when being switched to levothyroxine (L-T₄), occasionally did not feel as well despite adequate dosing based on serum TSH levels.
OBJECTIVE: Our objective was to investigate the effectiveness of DTE compared with L-T₄ in hypothyroid patients.
DESIGN AND SETTING: We conducted a randomized, double-blind, crossover study at a tertiary care center.
PATIENTS: Patients (n = 70, age 18-65 years) diagnosed with primary hypothyroidism on a stable dose of L-T₄ for 6 months were included in the study.
INTERVENTION: Patients were randomized to either DTE or L-T₄ for 16 weeks and then crossed over for the same duration.
OUTCOME MEASURES: Biochemical and neurocognitive tests at baseline and at the end of each treatment period were evaluated.
RESULTS: There were no differences in symptoms and neurocognitive measurements between the 2 therapies. Patients lost 3 lb on DTE treatment (172.9± 36.4 lb vs 175.7 ± 37.7 lb, P<.001). At the end of the study, 34 patients (48.6%) preferred DTE, 13 (18.6%) preferred L-T₄, and 23 (32.9%) had no preference. In the subgroup analyses, those patients who preferred DTE lost 4 lb during the DTE treatment, and their subjective symptoms were significantly better while taking DTE as measured by the general health questionnaire-12 and thyroid symptom questionnaire (P<.001 for both). Five variables were predictors of preference for DTE.
CONCLUSION: DTE therapy did not result in a significant improvement in quality of life; however, DTE caused modest weight loss and nearly half (48.6%) of the study patients expressed preference for DTE over L-T₄. DTE therapy may be relevant for some hypothyroid patients.