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. doi: 10.1210/jc.2012-4107. Epub 2013 Mar 28.

Abstract

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.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Animals
  • Cognition / drug effects
  • Cognition Disorders / chemically induced
  • Cognition Disorders / etiology
  • Cognition Disorders / prevention & control
  • Cross-Over Studies
  • Dietary Supplements* / adverse effects
  • Double-Blind Method
  • Female
  • Hormone Replacement Therapy* / adverse effects
  • Humans
  • Hypothyroidism / blood
  • Hypothyroidism / diet therapy*
  • Hypothyroidism / drug therapy
  • Hypothyroidism / physiopathology
  • Male
  • Middle Aged
  • Patient Preference
  • Quality of Life
  • Receptors, Thyroid Hormone / agonists*
  • Severity of Illness Index
  • Thyroid Gland / chemistry*
  • Thyroid Hormones / blood
  • Thyroxine / adverse effects
  • Thyroxine / therapeutic use*
  • Tissue Extracts / adverse effects
  • Tissue Extracts / therapeutic use*
  • Weight Loss / drug effects
  • Young Adult

Substances

  • Receptors, Thyroid Hormone
  • Thyroid Hormones
  • Tissue Extracts
  • Thyroxine