Date of Award

Winter 12-12-2022

Document Type


Degree Name

Doctor of Medical Science (DMSc)


Department of Physician Assistant Medicine

First Advisor

Justin M. Gambini, DMSc, PA-C, DFAAPA


Hypothyroidism is a chronic medical condition that results in the inadequate production of thyroid hormones. Thyroid hormones are essential for the metabolism of almost every organ in the body. The prominent symptoms of hypothyroidism include lack of energy, weight gain, constipation, and intolerance to cold temperatures. Medical therapies aim to replenish thyroid hormones enough to meet the body's metabolic demands. Unfortunately, many individuals experience persistent symptoms despite stable thyroid hormone levels. Current treatment options for hypothyroidism include Levothyroxine, Liothyronine, and Desiccated Thyroid Extract (DTE). Levothyroxine contains synthetic T4 and is the current gold-standard medical therapy in hypothyroid patients. Liothyronine, synthetic T3, can be added to Levothyroxine to improve symptomatology. DTE is a natural form of T3 and T4 and the historical first-line medical treatment. Combination therapy with Liothyronine or DTE is an option for symptomatic euthyroid patients on Levothyroxine monotherapy. Unfortunately, most primary care providers do not feel comfortable managing alternative regimens. This article’s focus is to review hypothyroidism treatment modalities while discussing their efficacy and reviewing current practice guidelines.