The current disease burden of primary hypothyroidism is estimated to be around 3% of the population in the UK. Treatment is intended to return thyrotrophin (TSH) levels to the normal range and improve symptoms, and reduce the impact on quality of life.

The statement first discusses when and how levothyroxine (T4) monotherapy should be initiated. It provides a useful summary of conditions and situations in which TSH may remain elevated despite apparently adequate doses of T4 being prescribed.

Whilst T4 has been the general mainstay of treatment for hypothyroidism, there are subsets of patients who do not find symptomatic benefit from conventional therapy. This statement discusses why this might be, and what additional/alternative treatment options are most commonly tried. Focusing on liothyronine (T3), it summarises where the current evidence base for T3 monotherapy and T3/T4 combination therapy stands.

This British Thyroid Association and Society for Endocrinology consensus statement outlines a recommended approach for supporting patients who wish to try T3 as a means of treating their hypothyroidism, centred around T3/T4 combination treatment. The recommendations do not advise T3 monotherapy except in the event of confirmed allergy to T4 or its excipients. The statement also provides advice on the practicalities of deprescribing T3 or dessicated thyroid extract. Variations in practice across the UK, and the need for more research in this area, are also highlighted.

Read the full article in Clinical Endocrinology doi:10.1111/cen.14935