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T3/T4: Cases from My Practice

The table below tracks cases in my practice (some features have been changed to protect patient identity); last update Oct 17, 2001. [Update Jan 2004:  I'll update the table soon.  In general most of those improved are still dramatically improved, including the one who put me on to all this -- she's going to graduate school now were before she couldn't hold a job.  However, one of my patients clearly did worse on T3/T4 than on T4 alone, and after that experience, I really backed off on this approach and haven't bothered updating the table.  

That's because with that one case it became clear to me that T3/T4 thyroid, used instead of T4 alone, can be harmful.  And one of the reasons I'd been exploring this approach so actively was that in theory it seemed very unlikely to be harmful (if TSH was kept in the normal range), and that therefore we didn't need as much evidence to consider using this approach, because even if it didn't work, it wasn't likely to be harmful -- or so I thought.   

However, the experience of the woman above who's now in graduate school suggests that there may be some people for whom this combined approach can be very helpful (hard to be too certain on the basis of that one patient, and a few more who are listed below).  One of these days I'll get around to writing her up as a case report.]  

Here then are the cases I collected back in 2001.  Asterisks mark cases with profound improvements akin to those seen with recognized mood stabilizers.

• Improved or much improved:     17/25     (68%)
  Note below how many of these people had a "normal" TSH prior to this treatment. 
• Worse:                                         5/21       (20%)
  These were my patients with most treatment resistant illness, early in my experience with T4/T3.  Note prevalence of diagnosis or possible diagnosis of "personality disorder" amongst those who worsened.  Note also that some were clearly started too high, in retrospect, most (but not all, interestingly) with TSH <0.5.  Finally, note that none have sustained worsening; all returned to prior baseline after thyroid was discontinued.
• No Change:                                 3/25       (12%)
  
• For Prescribers: clear improvement in mood stability with T3/T4, who did not improve on T4 alone:                                           10/13    ( 77%)
  These patients are marked with a bold case number.  Their experience supports the hypothesis that T3/T4 has substantially more mood stabilizing effects (like lithium and Depakote) than T4 alone.   

 

TABLE: Details by case: improved, worsened, no change, pending

Improved

No Change

Worse

Pending or uncertain (will move to improved, worse, or no change if course clarifies response)