Most patients feel well while taking levothyroxine. Despite optimizing therapy based on biochemical parameters, about 10% to 15% of patients do not feel that their therapy has restored their quality of life. After other potential causes of decreased quality of life have been fully addressed, individual use of combination therapy with addition of liothyronine can be considered and continued as long as patient benefit is maintained and overtreatment is avoided. Prior trials of combination therapy were largely underpowered, did not target dissatisfied patients, were of short duration, and used once-daily liothyronine dosing, potentially contributing to lack of patient benefit.
Sustaine -release preparations have entered clinical trials, and future combination ther- apy trials that address some of the design limitations of prior trials and use a sustained release liothyronine are anticipated
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