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As most of my readers know, the currently approved therapy for hypothyroidism is levothyroxine (T4). While technically T3 and combined T4/T3 therapy are also approved by FDA, the former is only used in severe cases of myxedema and the latter is considered obsolete and a remnant of the days when the use of natural dessicated thyroid (NDT) was the norm due to lack of purified/isolated T4 and T3. As such, hypothyroid patients have little choice but to submit to the T4 monotherapy if they want to keep their doctor and have the prescriptions/treatments be covered by their insurance policy. There is a plethora of evidence demonstrating that T4 monotherapy is ineffective for a large portion of hypothyroid patients and in fact could be making their symptoms worse. The doctors are at a loss of explaining why T4 monotherapy fails and usually invoke genetic factors as well as "non-compliance" by the patient with the prescribed dosage/regimen. However, the explanation (as the study below demonstrates) is actually much simpler. Considering T4 is actually a pro-hormone and depends on conversion into T3 (by the liver) in order to exert its therapeutic effects, it is plausible to expect observing lack of such conversion in patients in whom T4 monotherapy does not work. The reason for widespread lack T4-to-T3 conversion in hypothyroid patients is the already poor liver function in such people. Hopefully, the study below will catch the attention of endocrinologists and spur change in guidelines for treating hypothyroidism. The change I'd like to see is FDA either recommend T3 augmentation to the T4 therapy or allow T3 monotherapy in non-responding hypothyroid patients. It is a shame that millions of people are currently suffering needlessly when the evidence for a problem and its solution is so readily available.