title: Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  We conducted a randomized, double-blind, crossover study at a tertiary care center.
  
  
  METHODS
  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.
  
  
  METHODS
  Patients were randomized to either DTE or L-T₄ for 16 weeks and then crossed over for the same duration.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Endocrinology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, Maryland 20889-5600, USA.
authors.forename: Thanh D
authors.initials: TD
authors.lastname: Hoang
authors.forename: Cara H
authors.initials: CH
authors.lastname: Olsen
authors.forename: Vinh Q
authors.initials: VQ
authors.lastname: Mai
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Clyde
authors.forename: Mohamed K M
authors.initials: MK
authors.lastname: Shakir
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D003071:Cognition / Q000187:drug effects; D003072:Cognition Disorders / Q000139:chemically induced / Q000209:etiology / Q000517:prevention & control; D018592:Cross-Over Studies; D019587:Dietary Supplements / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D006801:Humans; D007037:Hypothyroidism / Q000097:blood / Q000178:diet therapy* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D011788:Quality of Life; D011988:Receptors, Thyroid Hormone / Q000819:agonists*; D012720:Severity of Illness Index; D013961:Thyroid Gland / Q000737:chemistry*; D013963:Thyroid Hormones / Q000097:blood; D013974:Thyroxine / Q000009:adverse effects / Q000627:therapeutic use*; D014020:Tissue Extracts / Q000009:adverse effects / Q000627:therapeutic use*; D015431:Weight Loss / Q000187:drug effects; D055815:Young Adult
chemical_list: D011988:Receptors, Thyroid Hormone; D013963:Thyroid Hormones; D014020:Tissue Extracts; D013974:Thyroxine