Journal of Endocrinological Investigation

, Volume 39, Issue 12, pp 1465–1474 | Cite as

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

  • B. BiondiEmail author
  • L. Bartalena
  • L. Chiovato
  • A. Lenzi
  • S. Mariotti
  • F. Pacini
  • A. Pontecorvi
  • P. Vitti
  • F. Trimarchi
Consensus Statement


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.


Hypothyroidism Replacement therapy TSH-suppressive therapy l-Thyroxine l-Triiodothyronine Deiodinases Clinical symptoms Quality of life Cognition Mood Depression Body weight Heart rate and patient preference for combined therapy Thyroidectomized patients Polymorphism in type 2 deiodinase gene 



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

Compliance with ethical standards

Conflict of interest

The panel members worked on this statement without any financial or commercial support.

Ethical approval

This article does not contain any study with human participants or animals performed by any of the authors.

Informed consent

No informed consent.


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Copyright information

© Italian Society of Endocrinology (SIE) 2016

Authors and Affiliations

  • B. Biondi
    • 1
    Email author
  • L. Bartalena
    • 2
  • L. Chiovato
    • 3
  • A. Lenzi
    • 4
  • S. Mariotti
    • 5
  • F. Pacini
    • 6
  • A. Pontecorvi
    • 7
  • P. Vitti
    • 8
  • F. Trimarchi
    • 9
  1. 1.Department of Clinical Medicine and SurgeryUniversity of Naples Federico IINaplesItaly
  2. 2.Department of Clinical and Experimental Medicine, ASST dei Sette Laghi, Ospedale di CircoloUniversity of InsubriaVareseItaly
  3. 3.Unit of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri and University of PaviaPaviaItaly
  4. 4.Department of Experimental Medicine, Medical Pathophysiology, Food and Science and Endocrinology SectionSapienza University of RomeRomeItaly
  5. 5.Endocrinology Unit, Department of Medical Sciences “M. Aresu”University of CagliariCagliariItaly
  6. 6.Department of Medical, Surgical and Neurological SciencesUniversity of SienaSienaItaly
  7. 7.Unità di EndocrinologiaUniversità Cattolica del Sacro CuoreRomeItaly
  8. 8.Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
  9. 9.Accademia Peloritana dei PericolantiUniversità di Messina MessinaItaly

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