Análisis crítico de un artículo:La terapia de reemplazo con la combinación de T3 con T4 no sería mejor que T4 sola en pacientes hipotiroideos

Análisis crítico de un artículo:La terapia de reemplazo con la combinación de T3 con T4 no sería mejor que T4 sola en pacientes hipotiroideos

Conflicting results have recently been published about the benefits of combined thyroxine (T4) and triiodothyronine (T3) in treating hypothyroid patients. However these studies may have been underpowered to detect differences in psychological well-being specifically related to thyroxine replacement....

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Autor principal: Téllez T,Rafael
Lenguaje:Spanish / Castilian
Publicado: Sociedad Médica de Santiago 2005
Acceso en línea:http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000900018
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spelling oai:scielo:S0034-988720050009000182005-11-09Análisis crítico de un artículo:La terapia de reemplazo con la combinación de T3 con T4 no sería mejor que T4 sola en pacientes hipotiroideosTéllez T,RafaelConflicting results have recently been published about the benefits of combined thyroxine (T4) and triiodothyronine (T3) in treating hypothyroid patients. However these studies may have been underpowered to detect differences in psychological well-being specifically related to thyroxine replacement. We conducted a large, double-blind, randomized controlled trial of partial substitution of 50 microg of T4 by 10 microg of T3 (T3) vs placebo (T4 alone - 50 microg of T4 replaced) in 697 hypothyroid patients. Thyroid function showed a rise in the TSH (132%), a fall in Free T4 (35%, P <0.001) and unchanged basal Free T3 levels (P=0.92). At 3 months there was a large (39%) «placebo effect» improvement in «psychiatric caseness» defined by the General Health Questionnaire 12 score (GHQ 12) in the control group compared with baseline and this was sustained at 12 months. Differences vs the intervention (T3) group were more modest with improvements in GHQ caseness (OR - 0.61; 95% CI: 0.42, 0.90; P=0.01) and HADS anxiety scores at 3 months (P <0.03) but not GHQ Likert scores, HADS depression, thyroid symptoms or visual analog scales of mood and the initial differences were lost at 12 months. These results may be consistent with a subgroup of patients showing transient improvement following partial substitution with T3 but do not provide conclusive evidence of specific benefit from partial substitution of T4 by T3 in patients on thyroxine replacement. They also emphasize the large and sustained «placebo effect» that can follow changes in thyroid hormone administrationinfo:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.133 n.9 20052005-09-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000900018es10.4067/S0034-98872005000900018
institution Scielo Chile
collection Scielo Chile
language Spanish / Castilian
description Conflicting results have recently been published about the benefits of combined thyroxine (T4) and triiodothyronine (T3) in treating hypothyroid patients. However these studies may have been underpowered to detect differences in psychological well-being specifically related to thyroxine replacement. We conducted a large, double-blind, randomized controlled trial of partial substitution of 50 microg of T4 by 10 microg of T3 (T3) vs placebo (T4 alone - 50 microg of T4 replaced) in 697 hypothyroid patients. Thyroid function showed a rise in the TSH (132%), a fall in Free T4 (35%, P <0.001) and unchanged basal Free T3 levels (P=0.92). At 3 months there was a large (39%) «placebo effect» improvement in «psychiatric caseness» defined by the General Health Questionnaire 12 score (GHQ 12) in the control group compared with baseline and this was sustained at 12 months. Differences vs the intervention (T3) group were more modest with improvements in GHQ caseness (OR - 0.61; 95% CI: 0.42, 0.90; P=0.01) and HADS anxiety scores at 3 months (P <0.03) but not GHQ Likert scores, HADS depression, thyroid symptoms or visual analog scales of mood and the initial differences were lost at 12 months. These results may be consistent with a subgroup of patients showing transient improvement following partial substitution with T3 but do not provide conclusive evidence of specific benefit from partial substitution of T4 by T3 in patients on thyroxine replacement. They also emphasize the large and sustained «placebo effect» that can follow changes in thyroid hormone administration
author Téllez T,Rafael
spellingShingle Téllez T,Rafael
Análisis crítico de un artículo:La terapia de reemplazo con la combinación de T3 con T4 no sería mejor que T4 sola en pacientes hipotiroideos
author_facet Téllez T,Rafael
author_sort Téllez T,Rafael
title Análisis crítico de un artículo:La terapia de reemplazo con la combinación de T3 con T4 no sería mejor que T4 sola en pacientes hipotiroideos
title_short Análisis crítico de un artículo:La terapia de reemplazo con la combinación de T3 con T4 no sería mejor que T4 sola en pacientes hipotiroideos
title_full Análisis crítico de un artículo:La terapia de reemplazo con la combinación de T3 con T4 no sería mejor que T4 sola en pacientes hipotiroideos
title_fullStr Análisis crítico de un artículo:La terapia de reemplazo con la combinación de T3 con T4 no sería mejor que T4 sola en pacientes hipotiroideos
title_full_unstemmed Análisis crítico de un artículo:La terapia de reemplazo con la combinación de T3 con T4 no sería mejor que T4 sola en pacientes hipotiroideos
title_sort análisis crítico de un artículo:la terapia de reemplazo con la combinación de t3 con t4 no sería mejor que t4 sola en pacientes hipotiroideos
publisher Sociedad Médica de Santiago
publishDate 2005
url http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000900018
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