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.
Introduction: Does T4+T3 combination therapy have an advantage over T4 monotherapy in improving mental health? Recently, scholars from Fujian Provincial Hospital in China conducted related research, and the research results were published in the journal CLINICAL ENDOCRINOLOGY
.
Hypothyroidism Treatment and Mental Health Clinical hypothyroidism is a common disorder defined as thyroid-stimulating hormone (TSH) concentrations above the reference range and free thyroxine (FT4) levels below the reference range
.
The lifetime risk of developing hypothyroidism is approximately 5%, and the prevalence of hypothyroidism ranges from 1% to 2% in areas with sufficient iodine
.
The prevalence in women is about ten times higher than in men
.
Patients with hypothyroidism are at increased risk for psychological disorders, such as depression, anxiety, and fatigue, that are often overlooked by clinicians
.
Since the 1970s, levothyroxine (LT4) has been the most commonly used drug for the treatment of hypothyroidism due to its effectiveness, low price, long half-life, and good compliance
.
However, some patients experience symptoms of hypothyroidism despite normal TSH levels, and adjusting the dose of LT4 may help slightly to improve mental health
.
Although previous studies and meta-analyses have shown disappointing effects of combination therapy on improving mental health, patients clearly prefer combination therapy
.
It is speculated that the methodological heterogeneity of clinical studies included in previous meta-analyses may mask the subtle advantages of combination therapy
.
This meta-analysis focused on exploring whether combination therapy has advantages over monotherapy in improving mental health
.
In addition, we performed subgroup analyses to explore whether methodological heterogeneity (including scale used, gender, ratio of T3 to T4 administration, or timing of T3 administration) influenced the results
.
The researchers searched PubMed, Embase, Cochrane Library and Web of Science for relevant studies
.
The main assessment indicators of the study included mental health assessment results of depression, fatigue, pain, anxiety and anger
.
T4+T3 combination therapy did not show a clear advantage.
A total of 18 studies involving 883 patients were included in this meta-analysis
.
The study data showed that T4+T3 combination therapy and T4 monotherapy were significantly associated with depression (standardized mean difference [SMD]: -0.
06, 95% [CI: -0.
18; 0.
07), fatigue (SMD: 0.
06, 95%CI: -0.
13; 0.
26), pain (SMD: -0.
01, 95%CI: -0.
24; 0.
22), anxiety (SMD: 0.
01, 95%CI: -0.
15; 0.
17), and anger (SMD: 0.
05, 95%CI: - 0.
15; 0.
24) were not significantly different
.
Methodological heterogeneity did not significantly affect the results, and patients significantly preferred combination therapy
.
Summary of this paper The original study showed that T4+T3 combination therapy had no clear advantage in improving mental health compared with T4 monotherapy
.
For patients who are dissatisfied with LT4 monotherapy, treatment decisions should be made jointly by the patient and the physician
.
Edited by Yimaitong: Lan H, Wen J, Mao Y, Huang H, Chen G, Lin W.
Combined T4+T3 Therapy Versus T4 Monotherapy Effect on Psychological Health in Hypothyroidism: A Systematic Review and Meta-analysis[J].
CLINICAL ENDOCRINOLOGY.
2022 Apr 20.
DOI: 10.
1111/cen.
14742, PMID:35445422