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To the Editor: Dr Clyde and colleagues¹ concluded that treatment of primary hypothyroidism with combination levothyroxine plus liothyronine was not superior to levothyroxine alone in terms of body weight, serum lipid levels, hypothyroid symptoms, or cognitive performance. Although Clyde et al recommend that patients should be treated with synthetic thyroid on the basis of cost, natural desiccated thyroid is considerably less expensive. Thus, perhaps this would be the most rational treatment choice.

Edward M. Lichten, MD
EML@usdoctor.com
Detroit, Mich

1. Clyde PW, Harari AE, Getka EJ, Shakir KMM. Combined levothyroxine plus liothyronine compared with levothyroxine alone in primary hypothyroidism: a randomized controlled trial. JAMA. 2003;290:2952-2958. FREE FULL TEXT

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291:1445.

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