Evidence mapPaperPMID 40795305Full record

SynthesisThe Journal of clinical endocrinology and metabolism2025

Risk of Death and Adverse Effects in Patients on Liothyronine: A Multisource Systematic Review and Meta-analysis.

Suhani Bahl, Peter N Taylor, Lakdasa D Premawardhana, Mike Stedman, Adrian Heald, Colin M Dayan, Onyebuchi E Okosieme

Abstract readMeta-AnalysisSystematic Review
In one paragraph

Synthesis in The Journal of clinical endocrinology and metabolism, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. EndoBridge 2025: pearls and highlights.Hormones (Athens, Greece) · 2026
    Review
  3. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors.

Suhani BahlThyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, Wales CF14 4XN, UK.ORCID 0009-0002-3216-896X
Peter N TaylorThyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, Wales CF14 4XN, UK.
Lakdasa D PremawardhanaThyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, Wales CF14 4XN, UK.
Mike StedmanRes Consortium, Andover SP10 5RG, UK.
Adrian HealdThe School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester M14 4PX, UK.
Colin M DayanThyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, Wales CF14 4XN, UK.
Onyebuchi E OkosiemeThyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, Wales CF14 4XN, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

contextAlthough some patients with hypothyroidism prefer combination therapy with liothyronine (LT3) and levothyroxine (LT4), the safety of LT3 remains unresolved.

objectiveWe undertook a multisource systematic review and meta-analysis of LT3 safety. DATA SOURCES: We searched PubMed for articles relating to death, adverse events (AEs), and cardiovascular outcomes in LT3 users. We also searched AEs data in the UK Yellow Card scheme and US Food and Drug Administration Adverse Reporting System (FAERS). DATA EXTRACTION: Data was extracted independently by 2 reviewers. Out of 1814 articles identified, 52 studies were selected, comprising 21 randomized controlled trials (RCTs), 4 cohort studies, and 27 case reports. Meta-analyses were conducted for adverse outcomes in RCTs and cohort studies of combination vs monotherapy. DATA SYNTHESIS: LT3-related AEs were only reported with unregulated LT3 use or pharmacy compounding errors. LT3 and LT4 showed similar adverse severity profiles in the Yellow Card scheme. Disproportionality analysis in the FAERS database showed no increased LT3 safety signals. A meta-analysis of RCTs (n = 2128) showed a similar AEs risk for combination vs monotherapy [relative risk (RR) 1.22, 95% confidence interval (CI) 0.66-2.25]. A cohort study meta-analysis (LT3 vs LT4-only users, n = 630 254) showed no increased risk of atrial fibrillation (RR 1.10, 95% CI 0.74-1.63), heart failure (RR 1.54, 95% CI 0.95-2.47), or strokes (RR 0.86, 95% CI 0.11-6.75), but reduced mortality risk was observed for LT3 (RR 0.70, 95% CI 0.62-0.78).

conclusionOur findings are reassuring that regulated LT3 use is not associated with the risk of death or serious AEs. More studies are needed to supplement existing data.

Indexed as

Hormone Replacement TherapyHypothyroidismTriiodothyronineDrug Therapy, CombinationHumansRandomized Controlled Trials as TopicThyroxineThyroxineTriiodothyronineadverse eventscardiovasculardeathhypothyroidismlevothyroxineliothyronine

Identifiers

PMID40795305
PMCPMC12527464

What Socratic holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.