European Thyroid Association Guidelines on L-T4 + L-T3 Combination for Hypothyroidism: A Weary Step in the Right Direction

This issue of the European Thyroid Journal features the European Thyroid Association (ETA) guideline on the use of L-T4 + L-T3 (levothyroxine + liothyronine) in the treatment of hypothyroidism [1]. Some time ago, the first author of the guideline invited me to speak at the annual ETA meeting on the very same topic. It was 5 years after the Bunevicius paper [2], which had already been followed by several larger studies aiming to address the question of whether combination treatment was more effective than L-T4 monotherapy. The newer studies at the time [3, 4, 5, 6] had confirmed my own personal clinical experience that tired patients on L-T4 continued to be tired patients on L-T4 + L-T3 . I made a few rather cynical remarks during my presentation, which got me some laughs by the audience. Unaware that I was speaking to anyone but colleagues, I was confronted at the end of my talk by an angry lady, who turned out to be a patient representative. She made sure I noted that her views and personal experience were very different to what I had portrayed. I had unintentionally offended a hypothyroid patient, which I regretted terribly, but after a lengthy discussion with her, which continued with occasional emails for several months, I was delighted to be asked to act as medical advisor for her thyroid patient-led organization. We remain friends and respect each other, though our views are still different.