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Recommendations for treatment of hypothyroidism with levothyroxine and levotriiodothyronine: a 2016 position statement of the Italian Society of Endocrinology and the Italian Thyroid Association

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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.

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Acknowledgments

The authors thank Prof. Leonidas Duntas, University of Athens, and Prof. Francesco Celi for their valuable suggestions in the preparation of the manuscript.

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Authors and Affiliations

  1. Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy

    B. Biondi

  2. Department of Clinical and Experimental Medicine, ASST dei Sette Laghi, Ospedale di Circolo, University of Insubria, Varese, Italy

    L. Bartalena

  3. Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri and University of Pavia, Pavia, Italy

    L. Chiovato

  4. Department of Experimental Medicine, Medical Pathophysiology, Food and Science and Endocrinology Section, Sapienza University of Rome, Rome, Italy

    A. Lenzi

  5. Endocrinology Unit, Department of Medical Sciences “M. Aresu”, University of Cagliari, Cagliari, Italy

    S. Mariotti

  6. Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy

    F. Pacini

  7. Unità di Endocrinologia, Università Cattolica del Sacro Cuore, Rome, Italy

    A. Pontecorvi

  8. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

    P. Vitti

  9. Accademia Peloritana dei Pericolanti, Università di Messina, Messina, Italy

    F. Trimarchi

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  1. B. Biondi
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  2. L. Bartalena
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Correspondence to B. Biondi.

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Biondi, B., Bartalena, L., Chiovato, L. et al. Recommendations for treatment of hypothyroidism with levothyroxine and levotriiodothyronine: a 2016 position statement of the Italian Society of Endocrinology and the Italian Thyroid Association. J Endocrinol Invest 39, 1465–1474 (2016). https://doi.org/10.1007/s40618-016-0511-z

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  • DOI: https://doi.org/10.1007/s40618-016-0511-z

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