Login to MyKarger

New to MyKarger? Click here to sign up.

Login with Facebook

Forgot your password?

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login
(Shibboleth or Open Athens)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

Clinical Thyroidology / Original Paper

Free Access

Treating Hypothyroidism with Thyroxine/Triiodothyronine Combination Therapy in Denmark: Following Guidelines or Following Trends?

Michaelsson L.F.a · Medici B.B.a · la Cour J.L.a, b · Selmer C.a · Røder M.c, d · Perrild H.e · Knudsen N.e · Faber J.a, f · Nygaard B.a

Author affiliations

aDepartment of Endocrinology, Herlev Hospital, University of Copenhagen, bDepartment of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, cDepartment of Medicine, Gentofte Hospital, University of Copenhagen, dDivision of Pharmacies and Reimbursement, Danish Health and Medicines Authority, eDepartment of Endocrinology, Bispebjerg Hospital, University of Copenhagen, and fFaculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

Corresponding Author

Luba Freja Michaelsson

Department of Endocrinology O

Herlev Hospital, University of Copenhagen

Herlev Ringvej 75, DK-2730 Copenhagen (Denmark)

E-Mail luba.freja.liubov.michaelsson@regionh.dk

Related Articles for ""

Eur Thyroid J 2015;4:174-180

Do you have an account?

Login Information

Contact Information

I have read the Karger Terms and Conditions and agree.


Background: Five to ten percent of patients with hypothyroidism describe persistent symptoms despite being biochemically well regulated on levothyroxine (L-T4). Thyroxine (T4)/triiodothyronine (T3) combination therapy [L-T4/liothyronine (L-T3) or desiccated thyroid] are still regarded as experimental with no evidence of superior effect on persistent symptoms according to meta-analyses. However, some randomized controlled trials have demonstrated patients' preference for T4/T3 combination therapy as compared to L-T4 monotherapy. In 2013, attention to combination therapy increased in Denmark after a patient published a book describing her experiences with hypothyroidism and treatment. Objective: To investigate current Danish trends in the use of T4/T3 combination therapy. Methods: We used an Internet-based questionnaire, distributed as a link via two Danish patient fora. Further, information was obtained from the Division of Pharmacies and Reimbursement at the Danish Health and Medicines Authority and from the only pharmacy in Denmark producing desiccated thyroid and L-T3 tablets. Results: A total of 384 patients answered the questionnaire, and 293 responders were included. Sixty-nine percent of the responders had six or more symptoms, and 84% reported a treatment effect. Forty-four percent of the responders received their prescriptions from general practitioners; 50% received desiccated thyroid and 28% reported that they adjust their dose themselves. Responders followed by general practitioners more frequently received desiccated thyroid and adjusted their dose themselves. Conclusions: Increased media focus has changed the prescription pattern of thyroid hormones; European guidelines on T4/T3 combination therapy are not always followed in Denmark and many patients adjust their medication themselves and may therefore be at risk of overtreatment.

© 2015 European Thyroid Association Published by S. Karger AG, Basel


  1. Stop the Thyroid Madness. www.stopthethyroidmadness.com/.
  2. Carle A, Laurberg P, Pedersen IB, Knudsen N, Perrild H, Ovesen L, Rasmussen LB, Jorgensen T: Epidemiology of subtypes of hypothyroidism in Denmark. Eur J Endocrinol 2006;154:21-28.
  3. Wiersinga WM, Duntas L, Fadeyev V, Nygaard B, Vanderpump MP: 2012 ETA guidelines: the use of L-T4 + L-T3 in the treatment of hypothyroidism. Eur Thyroid J 2012;1:55-71.
  4. Faber J, Selmer C: Cardiovascular disease and thyroid function. Front Horm Res 2014;43:45-56.
    External Resources
  5. Faber J, Galloe AM: Changes in bone mass during prolonged subclinical hyperthyroidism due to L-thyroxine treatment: a meta-analysis. Eur J Endocrinol 1994;130:350-356.
  6. Taylor PN, Razvi S, Pearce SH, Dayan CM: Clinical review: a review of the clinical consequences of variation in thyroid function within the reference range. J Clin Endocrinol Metab 2013;98:3562-3571.
  7. Annerbo S, Lökk J: A clinical review of the association of thyroid stimulating hormone and cognitive impairment. ISRN Endocrinol 2013;2013:856017.
  8. Grozinsky-Glasberg S, Fraser A, Nahshoni E, Weizman A, Leibovici L: Thyroxine-triiodothyronine combination therapy versus thyroxine monotherapy for clinical hypothyroidism: meta-analysis of randomized controlled trials. J Clin Endocrinol Metab 2006;91:2592-2599.
  9. Nygaard B, Jensen EW, Kvetny J, Jarlov A, Faber J: Effect of combination therapy with thyroxine (T4) and 3,5,3′-triiodothyronine versus T4 monotherapy in patients with hypothyroidism, a double-blind, randomised cross-over study. Eur J Endocrinol 2009;161:895-902.
  10. de Jong NW, Baljet GM: Use of T4, T4 + T3, and T3 in the Dutch population in the period 2005-2011. Eur Thyroid J 2012;1:135-136.
  11. Sydendal H: Få livet tilbage, ed 1. Holbaek, PH Medier, 2013.
  12. Carle A, Pedersen IB, Knudsen N, Perrild H, Ovesen L, Laurberg P: Hypothyroid symptoms and the likelihood of overt thyroid failure: a population-based case-control study. Eur J Endocrinol 2014;171:593-602.
  13. Thvilum M, Brandt F, Almind D, Christensen K, Brix TH, Hegedus L: Increased psychiatric morbidity before and after the diagnosis of hypothyroidism: a nationwide register study. Thyroid 2014;24:802-808.
  14. Thvilum M, Brandt F, Brix TH, Hegedüs L: Hypothyroidism is a predictor of disability pension and loss of labor market income: a Danish register-based study. J Clin Endocrinol Metab 2014;99:3129-3135.
  15. Taylor PN, Iqbal A, Minassian C, Sayers A, Draman MS, Greenwood R, Hamilton W, Okosieme O, Panicker V, Thomas SL, Dayan C: Falling threshold for treatment of borderline elevated thyrotropin levels-balancing benefits and risks: evidence from a large community-based study. JAMA Intern Med 2014;174:32-39.
  16. Cerqueira C, Knudsen N, Ovesen L, Laurberg P, Perrild H, Rasmussen LB, Jorgensen T: Doubling in the use of thyroid hormone replacement therapy in Denmark: association to iodization of salt? Eur J Epidemiol 2011;26:629-635.

Article / Publication Details

First-Page Preview
Abstract of Clinical Thyroidology / Original Paper

Received: May 08, 2015
Accepted: June 26, 2015
Published online: August 14, 2015
Issue release date: September 2015

Number of Print Pages: 7
Number of Figures: 2
Number of Tables: 4

ISSN: 2235-0640 (Print)
eISSN: 2235-0802 (Online)

For additional information: https://www.karger.com/ETJ

Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.