Combined Replacement Therapy With Levothyroxine and Liothyronine in Thyroidectomized Patients
Combined Replacement Therapy With Levothyroxine and Liothyronine in Thyroidectomized Patients
The aim of the study is to evaluate the peripheral tissue response to the combined
 administration of levothyroxine (LT4) and liothyronine (LT3) in hypothyroid patients with
 residual thyroid function virtually absent (thyroidectomized). Cases will be treated with
 LT4+LT3, at personalized doses according to clinical guidelines and respecting the circadian
 rhythmicity of LT3 and the physiological T3/T4 ratio. Controls will be treated with LT4 and
 placebo. Treatment duration: 24 weeks.

 The primary endpoint will be the peripheral effect of thyroid hormones, measuring tissue
 markers levels, such as thyroid stimulating hormone(TSH), sex hormone binding globulin
 (SHBG), total cholesterol, LDL cholesterol, lipoprotein A, osteocalcin, urinary
 N-telopeptide, ferritin, myoglobin, creatine kinase, glucose 6 phosphate dehydrogenases,
 angiotensin-converting enzyme (ACE). The secondary endpoints are bone and metabolic
 modifications, evaluated by DEXA, quality of life, tissue specific miRNA expression,
 polymorphisms of genes involved in thyroid hormones metabolism.
Inclusion Criteria:

 -  older than 18 years

 -  capable of consent

 -  able to fill in a questionnaire in italian

 -  thyroidectomized

 -  serum thyroglobulin levels below 0.2 ng/ml and antibodies anti-thyroglobulin
 undetectable (below normal range)

 -  well treated taking stable doses of levothyroxine in tablets, in the previous 3 months

 Exclusion Criteria:

 -  TSH suppressive therapy

 -  pregnancy

 -  cardiac arrhythmias

 -  severe liver, kidney or bone diseases

 -  ongoing steroids treatment

 -  ongoing or in the previous 12 months treatment with bone anti-resorptive, amiodarone,
 colestyramine or iron.