title: Recommendations for treatment of hypothyroidism with levothyroxine and levotriiodothyronine: a 2016 position statement of the Italian Society of Endocrinology and the Italian Thyroid Association.
abstract: Levothyroxine (L-T4) is recommended as lifelong replacement therapy for hypothyroidism. Recent clinical and experimental data support the addition of levotriiodothyronine (L-T3) treatment in some selected hypothyroid patients when their symptoms persist and their quality of life remains impaired despite adequate L-T4 monotherapy. An increase in L-T3 prescriptions has been recently observed in Italy due to availability of different L-T3 formulations, making it possible to clinicians to prescribe L-T3 alone or in combination with L-T4. The aim of the present position statement was to define the correct clinical indications, schedule, duration of treatment and contraindications of combined treatment with L-T4 and L-T3 in hypothyroid patients in an attempt to guide clinicians and to avoid potential adverse effects of overtreatment.
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy. bebiondi@unina.it.
authors.forename: B
authors.initials: B
authors.lastname: Biondi
authors.affiliation: Department of Clinical and Experimental Medicine, ASST dei Sette Laghi, Ospedale di Circolo, University of Insubria, Varese, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Bartalena
authors.affiliation: Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri and University of Pavia, Pavia, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Chiovato
authors.affiliation: Department of Experimental Medicine, Medical Pathophysiology, Food and Science and Endocrinology Section, Sapienza University of Rome, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Lenzi
authors.affiliation: Endocrinology Unit, Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Mariotti
authors.affiliation: Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Pacini
authors.affiliation: Unità di Endocrinologia, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Pontecorvi
authors.affiliation: Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Vitti
authors.affiliation: Accademia Peloritana dei Pericolanti, Università di Messina, Messina, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Trimarchi
mesh_terms: D020249:Hormone Replacement Therapy / Q000592:standards*; D006801:Humans; D007037:Hypothyroidism / Q000188:drug therapy*; D007558:Italy; D017410:Practice Guidelines as Topic / Q000592:standards*; D011788:Quality of Life; D013974:Thyroxine / Q000627:therapeutic use*; D014284:Triiodothyronine / Q000627:therapeutic use*
chemical_list: D014284:Triiodothyronine; D013974:Thyroxine
keywords: Body weight; Clinical symptoms; Cognition; Deiodinases; Depression; Heart rate and patient preference for combined therapy; Hypothyroidism; L-Thyroxine; L-Triiodothyronine; Mood; Polymorphism in type 2 deiodinase gene; Quality of life; Replacement therapy; TSH-suppressive therapy; Thyroidectomized patients