Antonio Bianco, MD, is the Charles Arthur Weaver Professor of Cancer Research in the Department of Internal Medicine. He is the president of Rush University Medical Group and vice dean for clinical affairs in Rush Medical College. Bianco came to Rush from the University of Miami Health System, where he served as professor of medicine and chief of the Division of Endocrinology, Diabetes and Metabolism. He has more than 30 years of experience in the thyroid field. He has been recognized with a number of national and international awards and membership in prestigious medical societies. A well-rounded investigator in the field of thyroid disease, Bianco led two American Thyroid Association task forces: one charged with drafting guidelines for thyroid research (as chair) and another responsible for developing guidelines for the treatment of hypothyroidism (co-chair). Bianco's research interests include the cellular and molecular physiology of the enzymes that control thyroid hormone action (the iodothyronine deiodinases). He has contributed approximately 250 papers, book chapters and review articles in this field, and has lectured extensively both nationally and internationally. Recently, he has focused on aspects of the deiodination pathway that interfere with treatment of hypothyroid patients, a disease that affects more than 10 million Americans. He directs an NIH-funded research laboratory where he has mentored almost 40 graduate students and postdoctoral fellows. This episode includes the following topics: Thyroid produces thyroxin of T4. T4 is not the biologically active, rather it is T3 T3 is biologically active Transformation of T4 to T3 happens throughs the body Levothyroxine has become the standard of care for treating hypothyroid patients T3 is the biologically active hormone, it could be by giving T4 only we are falling short Evidence based medicine wants to only treat with proven and documented therapy; T3 combination therapy is still not scientifically proven If patient takes T3 in the morning, it peaks about three hours later We have not developed a delivery system to maintain stable T3 levels The most important that we can challenge the pharmacy community is to deliver T3 in a way that it mimics the way it behaves in the human body Surveyed 12,000 patients and the ones on desiccated thyroid have higher QoL compared to those on Levothyroxine I was okay, I had a job, and then I had TT, and from that day forward my life is not the same. Brain fog, and lack motivation We do not yet have evidence proving that combination therapy works, but some patients report improvement to QoL Mood disorders, depression, brain fog, memory loss, and lack of motivation are reported by TT patients T3 combination therapy does not Many symptoms of hypothyroidism is similar to menopause Depression like symptoms, difficult for weight loss, low motivation, less desire for physical activity, brain fog, memory loss are all symptoms patients report post TT Cannot yet yet distinguish between positive effects of T3 and placebo effects Side effects of T3 may include palpitation or sweating Improvement with combination T3 can be immediate, as reported by patients Patients on Levothyroxine most likely to be on statins, beta-blockers, and anti depressants Blood tests for TT patients, taking T3 and not Time of day to take blood tests Time blood sample depending on when patient takes lab work. Ideally 3 or 4 hours after taking the T3 tablet Hypothyroid-like symptoms could be depression There is greater likelihood of depression symptoms for those taking Nearly 5% of the U.S. population takes T4 or Levothyroxine, as revealed by the NHANE survey. This means 10 – 15 million Americans. Levothyroxine is the most prescribed drug in the U.S. NOTES American Thyroid Association Bianco Lab A Controversy Continues: Combination Treatment for Hypothyroidism