Levothyroxine sodium 190microgram / Liothyronine 45microgram tablets

Background/Objectives: Thyroid hormones, considered safe in therapeutic doses, are used to treat hypothyroidism, a common condition. Due to a combination of factors, including their mechanism of action, availability, and low price, these drugs are used illegally, mainly to improve performance, to assist in weight loss, or for attempting suicide. Their overuse can lead to serious health consequences, including death. Although thyroid hormones are abused, there are no studies assessing the scale, characteristics, and consequences of their illegal use. The aim of this study was to evaluate case reports of thyroid hormone poisoning from the last 30 years, assessing their dynamics and characteristics. Methods: Full-text clinical case studies were obtained by searching PubMed, Google Scholar, MEDLINE, Embase, Web of Science, and Scopus for the following terms: "thyroid hormones", "thyroxine", "levothyroxine", "triiodothyronine", and "liothyronine", as well as "intoxication", "overdose", and "poisoning". This study adhered to Preferred Reporting for Systematic Reviews and Meta-analyses (PRISMA) guidelines for systematic reviews. Results: Thyroid hormones are abused particularly by athletes, persons trying to lose weight, or those attempting suicide. There has been an upward trend in thyroid hormone poisoning over the past 30 years, particularly since 2015. The same trend has been observed in cases of thyroid hormone use for doping, among other performance-enhancing drugs. Thyroid hormone use for doping was the most common cause of poisoning with these drugs, with other clinical manifestations from poisonings due to other causes. No upward trend has been observed in the use of thyroid hormones in suicide attempts since 2017, as this number remains stable. Conclusions: Although exploratory in nature, our work indicates that thyroid hormone poisoning, associated mostly with the illegal use of anabolic-androgenic steroids, exhibits an increasing tendency. Moreover, thyroid hormone abuse is an important issue in suicidology.

Abstract licence: CC BY

BackgroundWhile levothyroxine (L-T4) therapy is standard for hypothyroidism, its direct effects on specific echocardiographic parameters of cardiac function remain underexplored in comprehensive meta-analyses.MethodsWe systematically searched multiple databases up to June 2025 for randomized controlled trials and prospective cohort studies assessing L-T4 therapy on echocardiographic parameters in hypothyroid adults. Data on cardiac indices, intervention details, follow-up, and disease types were extracted. Risk of bias was assessed using standard tools. A random-effects model calculated mean differences (MDs) and assessed heterogeneity. Subgroup analyses evaluated treatment type, follow-up duration, and underlying disease.ResultsSix studies (2 RCTs and 4 cohort studies) were included. Overall, L-T4 intervention did not significantly alter the LV Tei Index (MD = 0.0214, 95% CI: -0.0294 to 0.0722, p=0.4083) or LVEF (MD = -0.2258, 95% CI: -0.8990 to 0.4475, p=0.5110). However, a statistically significant increase in Mitral E velocity (MD = -0.0646, 95% CI: -0.1138 to -0.0154, p=0.0100) and Mitral A velocity (MD = -0.0646, 95% CI: -0.1138 to -0.0154, p=0.0100) was observed. Subgroup analyses for LV Tei Index showed a statistically significant improvement in the 12-month follow-up subgroup (MD = 0.0672, 95% CI: 0.0161 to 0.1183) and in congenital hypothyroidism (MD = 0.0300, 95% CI: 0.0044 to 0.0556). For LVEF, a statistically significant increase was found in the 12-week follow-up subgroup (MD = -7.9300, 95% CI: -14.4844 to -1.3756) and the overt hypothyroidism subgroup (MD = -7.9300, 95% CI: -14.4844 to -1.3756). The effect of L-T4 on Mitral E and Mitral A velocities varied significantly across disease types (p=0.0304 for both), with a significant increase noted in the congenital hypothyroidism subgroup for both. No significant change was observed in the E/A ratio (MD = -0.0058, 95% CI: -0.0360 to 0.0244, p=0.7058), with no significant subgroup differences.ConclusionL-T4 exerts differential effects on echocardiographic measures of cardiac function, with specific improvements influenced by follow-up duration and underlying etiology.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/, CRD420251274519.

Abstract licence: CC BY

Objective This study aims to conduct a systematic review of the effectiveness and safety of Tripterygium Glycosides interventions in the treatment of Chinese patients with thyroid-associated orbitopathy (TAO). Methods A literature search was conducted using PubMed for English sources, and the CNKI, Chinese Biomedical Database, Wanfang Database, and VIP Database for Chinese sources. The search period extended from the beginning of the databases’ creation to Dec. 2023. The keywords used in the search were hyperthyroidism, thyroid-related immune orbitopathy (TRIO), ophthalmopathy, and Tripterygium Glycosides. Various combinations of search terms were used, depending on the database being queried. All the trials included in the study were clinical randomized controlled trials (RCTs). Results 33 RCTs or quasi-RCTs that met the inclusion criteria were included. The meta-analysis included 27 RCTs. 6 RCTs were excluded from the analysis due to the absence of a control group, but they were still included in the systematic review. 27 RCTs or quasi-RCTs involving 2,134 patients were included in the meta-analysis. The TRIO patients in the treatment group received Tripterygium Glycosides in combination with Thiamazole, Prednisone, Levothyroxine sodium, or a combination of these medications. While the TRIO patients in the control group were treated with Thiamazole, Prednisone, Levothyroxine sodium, or a combination of these treatments, the meta-analysis results show that the overall effectiveness rate of the treatment group and the control group was P = 0.05, I 2 = 0.33 0.5 [MD = 2.40, 95% CI (2.28, 2.51), P 0.5 [MD = 1.68, 95% CI (1.50, 1.85), P 0.5 [MD = 0.95, 95% CI (0.81, 1.08), P 0.5 [MD = 2.12, 95% CI (1.99, 2.25), P 0.5 [MD = −0.19, 95% CI (−0.21, −0.17), P Conclusion The experience with the treatment of TAO using Tripterygium Glycosides was promising. The existing evidence suggests that treatment with Tripterygium Glycosides may be more effective in enhancing the response rate, quality of life, and FT 3 levels compared to treatment with Prednisone, Levothyroxine sodium, and/or Thiamazole alone.

Abstract licence: CC BY

Abstract Disclosure: Y. Ayasa: None. A. Omarion: None. Z. Omarion: None. B. Jayouse: None. H. Ayesh: None. Background: Hypothyroidism, a common endocrine disorder, is predominantly treated with levothyroxine (LT4) monotherapy, which effectively normalizes thyroid-stimulating hormone (TSH) levels. However, many patients report persistent symptoms, including fatigue, cognitive difficulties, and diminished quality of life (QoL), despite achieving biochemical euthyroidism. This unmet need has driven interest in combination therapy with LT4 and liothyronine (LT3). While some studies suggest potential benefits of LT4+LT3 therapy in alleviating symptoms and improving QoL, the evidence remains inconsistent. This meta-analysis aims to provide a systematic evaluation of LT4 monotherapy and LT4+LT3 combination therapy in managing persistent hypothyroid symptoms.Methods:A systematic literature search of PubMed, Cochrane Library, and Scopus identified 25 studies, of which 8 met the inclusion criteria. The primary outcome was QoL improvement, assessed using validated tools such as SF-36 and ThyPRO. Secondary outcomes included symptom score changes and adverse events. Random-effects models were used for data synthesis, and heterogeneity was quantified using the I² statistic.Results:Five studies comparing LT4 and LT4+LT3 combination therapy reported QoL outcomes. The standardized mean difference (SMD) for QoL improvement with LT4+LT3 versus LT4 was 0.1185 (95% confidence interval [CI]: -0.0971 to 0.3342, p = 0.2813), indicating no significant difference. Analysis of symptom scale improvement from five studies demonstrated a small but statistically significant benefit for LT4+LT3 therapy (SMD: -0.3552, 95% CI: -0.5869 to -0.1236, p = 0.0026). Heterogeneity was moderate for symptom outcomes (I² = 30.5%) but high for QoL outcomes (I² = 70.1%).Conclusion:While LT4+LT3 combination therapy offers a modest improvement in symptom scores, it does not significantly enhance QoL compared to LT4 monotherapy. These findings suggest that combination therapy may benefit a subset of hypothyroid patients with persistent symptoms. Further large-scale, high-quality randomized controlled trials are needed to clarify its role in clinical practice. Presentation: Monday, July 14, 2025

Abstract licence: CC BY-NC-ND 4.0

BackgroundLevothyroxine (LTX) is one of the most commonly used medications due to the high prevalence of hypothyroidism in various age groups. Overdose (OD) with LTX, intentional or unintentional, is rare but can have clinically significant and even life-threatening consequences. Data on clinical outcomes of patients with LTX OD are limited, and guidelines on its management are suboptimal.AimTo compile all available data on the clinical characteristics, management, and outcomes of patients with LTX OD.MethodsA systematic literature search was conducted to identify English-language articles through PubMed, Scopus, and EMBASE that reported primary patient data on LTX OD in all age groups. All analyses were performed using STATA-18.ResultsForty-nine studies, comprising 95 individual cases and six larger retrospective studies (n = 11513), were analyzed. The median age of patients in case reports was 20 years (3.5-42), with a female preponderance (66.1%). The median ingested dose of LTX was 4250 μg (1250-10000), with a median time to presentation of 4.5 hours (1.5-24). Tachycardia (38.9%), confusion (23.2%), and fever (18.9%) were the most frequent symptoms. Severe complications included atrial fibrillation (5.3%), and one death was reported. Patients with intentional LTX OD were significantly older (median 35.5 vs 3.5 years, P P = 0.003), while non-intentional OD cases had higher heart rates (P = 0.02). Among the 11513 patients from larger studies, more than 90% experienced minimal or no symptoms, particularly in pediatric cohorts. Rarely severe outcomes, such as coma and cardiac failure, were observed in adults with high-dose ingestions, requiring interventions such as beta-blockers, corticosteroids, and plasmapheresis.ConclusionThis study provides the first comprehensive dataset on LTX OD. Patients with non-suicidal/accidental LTX OD mainly belong to the pediatric age group, while those with suicidal intent belong to the older age group. Despite the risk of toxicity with ingestion of high doses of LTX, mortality is extremely rare.

Abstract licence: CC BY-NC

Background: Levothyroxine (LT4) monotherapy is the standard treatment for hypothyroidism, using serum thyroid-stimulating hormone (TSH) as the primary indicator of therapeutic adequacy. However, many patients remain symptomatic despite achieving normal TSH levels. Objectives: This meta-analysis evaluates the biochemical and metabolic efficacy of adding liothyronine (T3) to LT4 compared to standard monotherapy. Method: A systematic search was conducted to identify randomized controlled trials (RCTs) comparing LT4+T3 combination therapy with LT4 monotherapy in adults. TSH was the primary outcome, while secondary outcomes included free T4 (fT4), total T3, lipid profiles, and body weight. Results: Seven RCTs involving 355 participants were analyzed. Biochemical outcomes showed no significant difference in TSH suppression (P=0.40) or total T3 levels (P=0.38) between groups. Notably, LT4 monotherapy resulted in significantly higher fT4 levels (MD=0.27; 95%CI: 0.13, 0.40; P=0.0001). Regarding metabolic outcomes, combination therapy significantly improved LDL cholesterol (MD=4.79; 95%CI: 1.63, 7.96; P=0.003) with zero heterogeneity (I2=0%). A borderline significant trend toward weight reduction was also observed in the combination group (MD=-2.26; 95%CI: -4.52, 0.01; P=0.05). Conclusion: Compared to monotherapy, LT4+T3 combination therapy provides significant metabolic advantages, particularly in LDL reduction, while maintaining biochemical euthyroidism.

Abstract licence: CC BY-SA 4.0