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Jan Kvetny

ABSTRACT

The effect of lithium on the peripheral turnover of T4 and T3 was investigated in 14 euthyroid subjects using lymphocytes as target cells. Lithium caused a dose-dependent rise in T4 turnover, which did not lead to increased T3 production, but no rise in T3 turnover. A further 3 patients with lithium induced hypothyroidism were studied. Patients with high T4 turnover had high TSH values and in these patients lithium induced a decrease in T4 turnover.

This may lead to the conclusion that the demonstrated effect of lithium in the control group did not cause the low T4 in these patients. In 2 patients defective T4 degradation was demonstrated.

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Jan Kvetny and Henning Kvist Poulsen

Abstract. Serum free T4, free T3, TSH and maximal nuclear binding capacity for T4 and T3 in mononuclear blood cells were measured in 12 control women, in 12 normal pregnant women in the first and in 12 women in the third trimester. Serum free T4 and T3 were decreased in late pregnancy compared to control women, serum free T4: 9.1 pmol/l (mean) vs 12.9 pmol/l (mean); serum free T3: 4.0 pmol/l (mean) vs 6.2 pmol/l (mean), without any change in TSH levels: 2.2 mU/l (mean) vs 1.8 mU/l (mean). Concomitantly, the maximal nuclear binding capacity for both T4 and T3 increased, T4: 2.7 fmol T4/100 μg DNA vs 1.8 fmol T4/100 μg DNA; T3: 2.8 fmol T3/100 μg DNA vs 2.0 fmol T3/100 μg DNA.

These data, obtained from healthy women during a normal pregnancy are compatible with mild compensated hypothyroidism. We suggest that euthyroidism are maintained by the increased maximal nuclear binding capacity for these hormones.

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Birte Nygaard, Ebbe Winther Jensen, Jan Kvetny, Anne Jarløv and Jens Faber

Background

Treatment of hypothyroidism with 3,5,3′-triiodothyronine (T3) is controversial. A recent meta-analysis concludes that no evidence is present in favour of using T3. However, the analysis included a mixture of different patient groups and dose-regimens.

Objective

To compare the effect of combination therapy with thyroxine (T4) and T3 versus T4 monotherapy in patients with hypothyroidism on stable T4 substitution.

Study design

Double-blind, randomised cross-over. Fifty micrograms of the usual T4 dose was replaced with either 20 μg T3 or 50 μg T4 for 12 weeks, followed by cross-over for another 12 weeks. The T4 dose was regulated if needed, intending unaltered serum TSH levels.

Evaluation

Tests for quality of life (QOL) and depression (SF-36, Beck Depression Inventory, and SCL-90-R) at baseline and after both treatment periods.

Inclusion criteria

Serum TSH between 0.1 and 5.0 mU/l on unaltered T4 substitution for 6 months.

Results

A total of 59 patients (55 women); median age 46 years. When comparing scores of QOL and depression on T4 monotherapy versus T4/T3 combination therapy, significant differences were seen in 7 out of 11 scores, indicating a positive effect related to the combination therapy. Forty-nine percent preferred the combination and 15% monotherapy (P=0.002). Serum TSH remained unaltered between the groups as intended.

Conclusion

In a study design, where morning TSH levels were unaltered between groups combination therapy, (treated with T3 20 μg once daily) was superior to monotherapy by evaluating several QOL, depression and anxiety rating scales as well as patients own preference.