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Authors’ Response: Patients on Appropriate T₄ Replacement Are as Content as They Would Be on Any Thyroid Hormone

Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada L8N 1G6

Address correspondence to: Anna M. Sawka, M.D., c/o Lehana Thabane, Center for Evaluation of Medicines, 105 Main Street East, Level P1, Hamilton, Ontario L8N 1G6, Canada.

To the editor:

Dr. Laurberg has suggested that one of the reasons that may explain, in part, the observations of a decreased sense of general well-being in some treated hypothyroid patients may be that there is "bias in diagnosing and therapy" (1). Dr. Laurberg has specifically commented on data suggesting that individuals who are treated with thyroid hormone are more likely to have both a high General Health Questionnaire score and other medical comorbidities, such as diabetes, cardiac disease, stroke, hypertension, epilepsy, and depression (2, 3). We agree with Dr. Laurberg that these data are consistent with the possibility that patients presenting with symptoms of depression, general sense of a lack of well-being, or other medical conditions (which may themselves be associated with decreased quality of life, such as diabetes) may be more likely to be screened for, diagnosed with, and treated for hypothyroidism. Such symptoms may be persistent, despite T₄ therapy (particularly if hypothyroidism is not the cause of the impaired well-being), and the depressed quality of life noted in T₄-treated patients may be wrongly attributed to T₄ therapy itself. Such an explanation may explain, in part, the lack of effect of the addition of T₃ to T₄ therapy (in patients with a normal TSH) in improving general sense of well-being, as seen in our study (4). If further trials of T₃ therapy fail to detect a benefit on well-being, the need to look at nonthyroidal approaches may be more pressing.

Received January 23, 2004.

Accepted January 23, 2004.

References

1. Laurberg P 2004 Patients on appropriate T₄ replacement are as content as they would be on any thyroid hormone. J Clin Endocrinol Metab 89:2507 (Letter)[Free Full Text]
2. Kaplan MM, Sarne DH, Schneider AB 2003 Editorial: in search of the impossible dream? Thyroid hormone replacement therapy that treats all symptoms in all hypothyroid patients. J Clin Endocrinol Metab 88:4540–4542[Free Full Text]
3. Saravanan P, Chau F, Roberts V, Vedhara K, Greenwood R, Dayan CM 2002 Psychological well-being in patients on ‘adequate’ doses of L-thyroxine: results of a large, controlled community-based questionnaire study. Clin Endocrinol (Oxf) 57:577–585[CrossRef][Medline]
4. Sawka AM, Gerstein HC, Marriott MJ, MacQueen GM, Joffe RT 2003 Does a combination regimen of thyroxine (T₄) and 3,5,3'-triiodothyronine improve depressive symptoms better than T₄ alone in patients with hypothyroidism? Results of a double-blind, randomized, controlled trial. J Clin Endocrinol Metab 88:4551–4555[Abstract/Free Full Text]

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