Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: Dr Lichten emphasizes the importance
of considering costs when choosing between different medications with similar
therapeutic efficacies. However, the objective of our study was to investigate
the efficacy of levothyroxine plus liothyronine compared with levothyroxine
monotherapy in primary hypothyroidism. We did not assess the efficacy of desiccated
thyroid or the cost effectiveness of different thyroid hormone preparations.
If administered as in our study, liothyronine (Cytomel, King Pharmaceuticals,
St Louis, Mo) 7.5 µg twice daily, along with levothyroxine, the cost
of the liothyronine component alone would be over $100 for a 90-day supply.1 The brand of levothyroxine (Synthroid, Abbott Laboratories,
Abbott Park, Ill) we used was simply the brand carried on our institution's
pharmacy formulary. To provide thyroid hormone therapy in a similar manner
to that used in our study, desiccated thyroid would need to be taken twice
daily, since desiccated thyroid does not provide a slow-release form of triiodothyronine
(T3). The economic cost of therapy would then become at least as
much as that of levothyroxine monotherapy.
Clyde PW, Harari AE, Shakir KMM. Synthetic Thyroxine vs Dessicated Thyroid—Reply. JAMA. 2004;291(12):1445. doi:10.1001/jama.291.12.1445-b