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Thyroxine, also known as T 4, is a hormone produced by the thyroid gland. It is the primary form of thyroid hormone found in the blood and acts as a prohormone of the more active thyroid hormone, triiodothyronine (T 3 ). [ 1 ]
The related drug dextrothyroxine (D-thyroxine) was used in the past as a treatment for hypercholesterolemia (elevated cholesterol levels), but was withdrawn due to cardiac side effects. [citation needed] Once weekly thyroxine (OWT) preparations are also available for clinical use.
Liothyronine may be used when there is an impaired conversion of T 4 to T 3 in peripheral tissues. [2] The dose of liothyronine for hypothyroidism is a lower amount than levothyroxine due it being a higher concentrated synthetic medication. [2]
The effects of T 4 in vivo are mediated via T 3 (T 4 is converted to T 3 in target tissues). T 3 is three to five times more active than T 4. T 4, Thyroxine (3,5,3′,5′-tetraiodothyronine), is produced by follicular cells of the thyroid gland.
Dextrothyroxine (trade name Choloxin) is a dextrorotary isomer of thyroxine. [1] It saw research as a cholesterol-lowering drug [2] but was pulled due to cardiac side-effects. It increases hepatic lipase which in turn improves utilization of triglycerides and decreases levels of lipoprotein(a) in blood serum. [3]
Adding liothyronine to levothyroxine has been suggested as a measure to provide better symptom control, but this has not been confirmed by studies. [9] [16] [66] In 2007, the British Thyroid Association stated that combined T 4 and T 3 therapy carried a higher rate of side effects and no benefit over T 4 alone.
There is debate as to whether thyroxine degrades the motor end plates from the muscular side, from the nervous system side, or a combination. [ 1 ] To understand how high levels of thyroxine can be toxic and lead to thyrotoxic myopathy physiologically, consider basic neuromuscular junction function.
[15] However, subgroup analysis found that patients who remain the most symptomatic while taking levothyroxine may benefit from therapy containing liothyronine. [15] There is a lack of evidence around the benefits, long-term effects and side effects of dessicated thyroid extract. It is no longer recommended for the treatment of hypothyroidism. [78]
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