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Bioidentical Thyroid Replacement Therapy in Practice: Delivering a Physiologic T4-T3 Ratio for Improved Patient Outcomes with the Listecki-Snyder Protocol

Author(s):  Snyder Scott, Listecki Robert E

Issue:  Sep/Oct 2012 - Volume 16, Number 5
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Note:  Electronic version includes supplemental material.

Abstract:  Effective thyroid replacement therapy may be elusive to some patients, and compounding pharmacists have an opportunity to deliver more effective therapy. Goodman & Gilman's The Pharmacological Basis of Therapeutics 12th edition states that the body usually secretes T4:T3 in an 11:1 ratio but cautions against pursuing combined thyroid replacement due to the short halflife of T3 that necessitates multiple daily dosing; no commercial availability and lack of benefit were shown in trials.1 Commercial combinations of T4/T3 such as Armour Thyroid and Nature-Thyroid have a 4.22:1 T4:T3 ratio. Applying the same concept as bioidentical hormone replacement therapy, compounding pharmacists can deliver an 11:1 ratio using a commercial T4 product and taking into account oral bioavailability of each entity. The short half-life of T3 can be remedied by taking the patient’s daily T3 dose and dividing it into two slow-release capsules to be dosed every 12 hours.

Related Keywords: Scott Snyder, Robert Listecki, RPh, thyroid hormone deficiency, hypothyroidism, thyroid replacement, oral bioavailability, slow-release preparation, literature review, combination T4/T3 therapy, formulation, levothyroxine, T4, liothyronine, T3

Related Categories: FORMULATIONS, HRT, ENDOCRINOLOGY/HORMONES/ MENOPAUSE/ANDROPAUSE, LITERATURE REVIEW, PATIENT ASSESSMENT

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