Do you feel like the weight of gravity is setting in? You keep telling yourself, that you’re too young to feel old, but your aching muscles, sore joints, and decreased energy tell you otherwise.

What are some key factors to feeling old?

• Oxidative stress from diets high in sugar and processed foods
• Inflammation from diets high in hydrogenated oils
• Raised cortisol levels from poorly managed stress
• Overuse of prescription drugs
• Dehydration and large amounts of soda consumption
• Sleep deprivation
• Low thyroid function
• Hormone imbalances

While life expectancy for humans has increased, for many individuals the quality of life has decreased. According to the World Health Organization, the United States ranks 37th in the world when it comes to overall health.1 More Americans are experiencing obesity, heart disease, cancer, and diabetes. Surprisingly, women in other countries do not suffer from symptoms of hormonal imbalance to the extent that American women experience PMS, endometriosis, fibroid tumors and menopausal symptoms.

Why do Americans suffer more from health ailments? A key factor is found within hormonal imbalances. For women, an extremely common hormone imbalance is “estrogen-dominance.”

Estrogen-dominance

Severe symptoms of menopause, PMS, heavy menstrual bleeding, and endometriosis, as well as the progression of fibroid tumors and cancer, can all be related to estrogen-dominance.2,3,4Estrogen is a primary hormone found in men and women. While it is necessary for cardiovascular health, reproduction, bone development, and cognitive function, an excessive amount of estrogen can cause health problems.

How does estrogen-dominance develop? Obesity can be a major factor in estrogen-dominance, as estrone (a form of estrogen) is stored in fat cells.5 Another source can be found in compounds known as PCBs, BPAs, and Phthalates.6 These materials contain xenoestrogens (estrogen-like chemicals) that can be found in plastics, petroleum-based products, and household cleaning supplies. Xenoestrogens can also be found in herbicides, pesticides, and insecticides that are used on our food supply. These compounds can cause significant health ailments, including estrogen-related cancers.7 The high-fat, western diet that is based on refined, processed foods and saturated animal fats can also contribute to estrogen-dominance.8

While obese men store more estrone, they typically aren’t affected with estrogen-dominance. However, men can experience testosterone deficiency as they age, which can lead to increased body fat, low libido, mood imbalances, fatigue, and cardiovascular ailments.9

If you have concerns about hormone imbalances, you can check your hormone levels with simple blood tests. A hormone imbalance or deficiency can be safely and effectively treated with bioidentical hormone replacement. Maintaining healthy hormone levels can help restrain significant health problems, including cardiovascular disease, cancer, diabetes, obesity, depression, and menopausal symptoms.10,11,12

References

1. Murray CJ, Frenk J. Ranking 37th – measuring the performance of the U.S. health care system. N Engl J Med. 2010 Jan;362(2):98-99.
2. Ashby J, Tinwell H, Plautz J, et al. Lack of binding to isolated estrogen or androgen receptors, and inactivity in the immature rat uterotrophic assay, of the ultraviolet sunscreen filters Tinosorb M-active and Tinosorb S. Regul Toxicol Pharmacol. 2001;34(3):287–291.
3. Bentrem D, Fox JE, Pearce ST, et al. Distinct molecular conformations of the estrogen receptor alpha complex exploited by environmental estrogens. Cancer Res. 2003;63(21):7490–7496.
4. Kubista E. [Diagnosis and therapy of fibrocystic breast disease]. Zentralbl Gynakol. 1990; 112(17):1091–1096.
5. Turner N. The Hormone Diet: A 3-Step Program to Help You Lose Weight, Gain Strength, and Live Younger Longer. New York, NY: Rodale;2009.
6. Tapiero H, Ba GN et al. Estrogens and environmental estrogens. Biomed Pharmacother. 2002 Feb;56(1):36–44.
7. Fucic A, Gamulin M, Ferenic Z, Katic J, et al. Environmental exposure to xenoestrogens and oestrogen related cancers: reproductive system, breast, lung, kidney, pancreas, and brain. Environ Health. 2012 Jun;11(1):S8.
8. Hall DC. Nutritional influences on estrogen metabolism. Applied Nutritional Science Reports. 2001:1-8.
9. Watt PJ, Hughes RB, et al. A holistic programmatic approach to natural hormone replacement. Fam Community Health. 2003;25(1):53-63.
10. Walsh B and Schiff I. Menopause. In Principles and Practice of Endocrinology and Metabolism. New York : Lippincott, Williams and Williams;2001.
11. Cameron DR , Braunstein GD. Androgen replacement therapy in women. Fertil Steri. 2004;82(2):273-289.
12. Formby B, Wiley TS. Progesterone inhibits growth and induces apoptosis in breast cancer cells: inverse effects on Bcl-2 and p53. Ann Clin Lab Sci. 1998;28(6):360–369.

Hormone replacement therapy (BHRT) has been around for many years as a way to help women relieve menopausal symptoms. Yet, HRT has been a confusing topic for medical professionals and patients. The debate over the safety of HRT has been questioned since the Women’s Health Initiative study in 2002, which showed the therapy could have greater health risks than benefits.1,2

To clarify this study, researchers found that women taking Prempro (a combination of Premarin and Progestin) significantly increased breast cancer, heart attack, and stroke risks. Due to the chemical makeup of these synthetic treatments, they can have negative effects on the body. Fortunately, there are alternatives to conventional BHRT. Bioidentical hormones are another method for treating menopause and hormonal imbalances. This form of HRT comes from natural compounds and contains a molecular structure that is identical to hormones found in the body. The body uses BHRT the same way it uses hormones naturally produced in the body.

Hormones in the body are vital messengers that communicate between body tissues. When hormone levels become unbalanced or decrease, they can leave you feeling exhausted, irritable, depressed, and wear on your physical and mental abilities. If they stay unbalanced for too long, they can lead to greater health risks, including cardiovascular disease, osteoporosis, cognitive ailments, and certain forms of cancer.3,4

When should you consider taking BHRT?

There are different reasons to consider BHRT, but it is most commonly used for menopause or significant hormone imbalances. The need for HRT can be clearly defined through simple blood tests to determine your hormone levels.

Menopause – Symptoms of menopause are a common frustration among middle-aged American women. Menopause can be recognized with the development of hot flashes, night sweats, sleep disturbances, depression, mood swings, low libido, fatigue, vaginal dryness, poor concentration, and unexplained weight gain.5

PMS – The main cause of PMS is too much estrogen and not enough progesterone. PMS symptoms can be characterized with mood swings, bloating, heavy bleeding, breast tenderness, acne, migraine headaches, severe menstrual cramps, and fatigue. Women who have PMS are more susceptible to postpartum depression. Progesterone levels that are significantly high during pregnancy decrease rapidly after women deliver a baby, which can lead to postpartum depression.6

Andropause – Andropause is similar to menopause, but it affects men. It is mostly recognized through low libido, but other symptoms may include fatigue, increased irritability, loss of motivation, abdominal weight gain, decreased strength, and even occasional hot flashes. This can all be associated with a decrease in testosterone levels. Low testosterone levels can leave men more prone to cardiovascular disease and prostate cancer.7

Supplementing with bioidentical hormone replacement therapy can restore and balance hormone levels to increase quality of life and offer greater protection against various chronic diseases.

References

1. Rossouw E. Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial, JAMA. 2002;288:321–333.

2. Gambrell RD. The Women’s Health Initiative reports: Critical review of the findings. The Female Patient. 2004; 29:25-41.

3. Holtorf K. The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy? Postgrad Med. 2009 Jan;121(1):73-85.

4. Formby B, Wiley TS. Progesterone inhibits growth and induces apoptosis in breast cancer cells: inverse effects on Bcl-2 and p53. Ann Clin Lab Sci. 1998; 28(6): 360–369.

5. Newton KM, Buist DS, Keenan, NL, Anderson LA, LaCroix AZ. Use of alternative therapies for menopause symptoms: results of a population-based survey. Obstet Gynecol. 2002 Jul;100(1):18-25.

6. Pearlstein T, Howard M, Salisbury A, Zlotnick C. Postpartum depression. Am J Obstet Gynecol. 2009 Apr;200(4):357-364.

7. Hoffman MA, DeWolf WC, Morgentaler A. Is low serum free testosterone a marker for high grade prostate cancer? J Urol. 2000 Mar; 163(3):824-827.

The Alzheimer’s Association has estimated that the incidence of Alzheimer’s disease in the United States will more than double in the next 40 years. Currently 5.2 million Americans suffer from Alzheimer’s, but 13.8 million Americans are expected to by 2050. As a result, medical costs will increase to more than $1.2 trillion per year by 2050.1 And the cumulative costs for Alzheimer’s care from 2010 to 2050 is estimated to exceed $20 trillion.2

What can be done to prevent cognitive decline?

Reduce Abdominal Fat

Your belly affects your brain? It may seem like an odd connection, but a recent study conducted on more than 700 middle-aged subjects found that obesity lowered total brain volume in healthy middle-aged individuals. Lower total brain volume has been linked to the development of dementia and Alzheimer’s later in life. The findings, published in the Annals of Neurology, suggested that insulin resistance and BMI did not correlate to dementia, but visceral abdominal fat was significantly related.3

Exercise

Everyone knows that exercise is good for us and we should be exercising regularly. It has been shown to help combat heart disease, high blood pressure, diabetes, depression, sleep disorders, and many circulatory issues.4-7 But, did you know physical exercise can actually improve how the brain functions? Studies are increasingly demonstrating that exercise can improve memory and processing speed, and even slow down cognitive impairment.8-16Based on the accumulation of evidence, regular exercise will soon be prescribed even to prevent  Alzheimer’s disease.17 Evidence is also mounting regarding exercise and its beneficial effects on Parkinson’s disease.18,19

Listen to Music

According to a study conducted at Boston University School of Medicine, Alzheimer’s patients can remember verbal information significantly better when it is set to music. Alzheimer’s patients and healthy older adults were recruited to listen to spoken words or words set to music. The results indicated Alzheimer’s patients were more accurate on memory tests when the words were set to music. Healthy older adults did not derive any significant benefits from listening to musical words. It was concluded that Alzheimer’s patients had significant memory improvements because music improved brain processes that function at a slower rate when Alzheimer’s is present.20 Two years later, more research also backed up the use of music in treating Alzheimer’s.21

Drink Blueberry Juice

Blueberries are loaded with health promoting phytochemicals, which have antioxidant and anti-inflammatory properties. Polyphenols and anthocyanins can slow decline in memory function by increasing cognitive signals and assisting glucose metabolism in the brain. Researchers found that individuals with memory decline showed significant improvement in learning and memory tests when they consumed 2 ½ cups of blueberry juice every day for 12 weeks.22

Polyphenols found in berries (especially the berries’ flavonoid content) have been associated with improvement in neuronal functioning with aging and cogntion. Concord grape juice has a variety of polyphenols including anthocyanins and flavonols. A 2012 study published in theJournal of Agricultural Food Chemistry showed that concord grape juice could enhance neurocognitive function in older people with mild cognitive impairment.23

References

1. Alzheimer’s Association 2013 Alzheimer’s Disease Facts and Figures. Retrieved on September 2, 2013 http://www.alz.org/alzheimers_disease_facts_and_figures.asp
2. Alzheimer’s News 5/19/10. Report: Alzheimer’s disease to cost United States $20 trillion over next 40 years. Retrieved on September 2, 2013 from http://alz.org/news_and_events_19623.asp
3. Debette S,  et al. Visceral fat is associated with lower brain volume in healthy middle-aged adults. Annals of Neurology. Published online early. May 20, 2010.
4. Kligman EW, Pepin E. Prescribing physical activity for older patients. Geriatrics. 1992 Aug;47(8):33-4, 37-44, 47.
5. O’Grady M, Fletcher J, Ortiz S. Therapeutic and physical fitness exercise prescription for older adults with joint disease: an evidence-based approach. Rheum Dis Clin North Am.2000 Aug;26(3):617-46. Review.
6. Koivula RW, Tornberg AB, Franks PW. Exercise and diabetes-related
   cardiovascular disease: systematic review of published evidence from
   observational studies and clinical trials. Curr Diab Rep. 2013 Jun;13(3):372-80.
7. Kemmler W, et al. Long-term exercise and risk of metabolic and cardiac diseases: the erlangen fitness and prevention study. Evid Based Complement Alternat Med.2013;2013:768431. doi: 10.1155/2013/768431. Epub 2013 Jul 30.
8. Özkaya GY, et al. Effect of strength and endurance training on cognition in older people. J Sports Sci & Med 2005; 4: 300-313.
9. Perrig-Chiello P, et al. The effects of resistance training on well-being and memory in elderly volunteers. Age Ageing 1998; 27: 469-475.
10. Cassilhas RC, et al. The impact of resistance exercise on the cognitive function of the elderly. Med Sci Sports Exerc 2007; 39: 1401-1407.
11. Smith GS. Aging and neuroplasticity. Dialogues Clin Neurosci. 2013 Mar;15(1):3-5.
12. Berchicci M, et al. Benefits of Physical Exercise on the Aging Brain: The Role of the Prefrontal Cortex. J Gerontol A Biol Sci Med Sci. 2013 Jul 5. [Epub ahead of print] PubMed PMID: 23833198.
13. Hayes SM, et al. A review of cardiorespiratory fitness-related neuroplasticity in the aging brain. Front Aging Neurosci. 2013 Jul 12;5:31.
14. Hötting K, Röder B. Beneficial effects of physical exercise on neuroplasticity and cognition. Neurosci Biobehav Rev. 2013 Apr 25. doi:pii: S0149-7634(13)00101-2.
15. Erickson KI, et al. Physical activity and brain plasticity in late adulthood. Dialogues ClinNeurosci. 2013 Mar;15(1):99-108.
16. McDonnell MN, et al. A single bout of aerobic exercise promotes motor cortical neuroplasticity. J Appl Physiol. 2013 May;114(9):1174-82.
17. Farina N, Rusted J, Tabet N. The effect of exercise interventions on cognitive outcome in Alzheimer’s disease: a systematic review. Int Psychogeriatr. 2013 Aug  20:1-10.
18. Rose MH, et al. Improved clinical status, quality of life, and walking capacity in Parkinson’s disease after body weight-supported high-intensity locomotor training. Arch Phys Med Rehabil. 2013 Apr;94(4):687-92.
19. Filippin NT, et al. Effects of treadmill-walking training with additional body load on quality of life in subjects with Parkinson’s disease. Rev Bras Fisioter. 2010 Jul-Aug;14(4):344-50.
20. Simmons-Stern NR, Budson AE, Ally BA. Music as a memory enhancer in patients with Alzheimer’s disease. Neuropsychologia. 2010 Aug;48(10):3164-7.
21. Simmons-Stern NR, et al. Music-based memory enhancement in Alzheimer’s disease: promise and limitations. Neuropsychologia. 2012 Dec;50(14):3295-303.
22. Krikorian R, Shidler MD, Nash TA, et al. Blueberry supplementation improves memory in older adults. J Agric Food Chem. 2010, 58(7):3996-4000.
23. Krikorian R, et al. Concord Grape Juice Supplementation and Neurocognitive Function in Human Aging. J Agric Food Chem. 2012 Apr 9. [Epub ahead of print] PubMed PMID: 22468945.

Live long and prosper. What can you do to have a longer, happier life? In addition to a eating a balanced diet and exercising regularly, life expectancy is related to your attitude, behavior, and beliefs.

Be Positive

Is the glass half full or half empty? Your attitude and perspective on the world contribute largely to your health.1Individuals who have a positive outlook when they are young tend to live longer.2 In a study where participants over the age 50 were followed for 30 to 40 years, researchers found that the individuals who had a positive attitude about aging lived about seven years longer than those who did not.3 Those who tend to hold on to negative emotions are more likely to experience harmful health outcomes, including heart ailments.4-6

If you find yourself feeling more hostile, bitter, and depressed, try to become an extrovert. Get involved in a community group, enroll in a community class, reach out to new people or try a new hobby that includes other people. Doing so will help you feel more positive and involved.

Be Conscientious

Just like keeping a positive attitude, personality traits impact longevity. Researchers have found that individuals who are more conscientious, organized, reliable, and competent live longer. A meta-analysis of 20 different studies dealing with a conscientious nature and longevity found that achievement (persistence, industrious nature) and order (organized, disciplined) were significantly related to longevity. Furthermore, conscientious people are less likely to smoke and more likely to have a stable marriage and job.7

Serve Others

By doing good works for other people, you can boost antibodies that stimulate the immune system, hormones, and cognitive function. Older individuals who volunteer have a sense of being needed and valued, which may be another underlying reason for greater longevity among those who volunteer.8

Reach out and get involved by becoming a mentor for an adolescent. People find great meaning in their service when they can help someone younger.

Socialize with Good Friends

Strong connections with friends can support a healthy immune system. Confiding in a good friend or family member can release negative emotions and tension. Furthermore, studies find that married people tend to live longer than those who are single.9,10

Prayer & Meditation

Our beliefs can play a role in overall health. Religious individuals tend to live longer by being involved in a community congregation. Additionally, religious people tend to avoid substance abuse that can weaken health. Researchers found that people attending a weekly religious service were 46% less likely to die over a six-year period than those who attended services less often.11 Furthermore, beliefs can bring comfort and peace to religious individuals, reducing negative stress and despair.

References

1. Carver CS, Connor-Smith J. Personality and coping. Annu Rev Psychol. 2010;61:679-704.
2. Ringbäck Weitoft G, et al. Is perceived nervousness and anxiety a predictor of premature mortality and severe morbidity? A longitudinal follow up of the Swedish survey of living conditions. J Epidemiol Community Health. 2005 Sep;59(9):794-8.
3. Levy BR, Slade MD, Kunkel SR, Kasl SV. Longevity increased by positive self-perceptions of aging. J of Personality & Soc Psychol. 2002;83(2):261-270.
4. Brydon L, et al. Dispositional optimism and stress-induced changes in immunity and negative mood. Brain Behav Immun. 2009 Aug;23(6):810-6.
5. Stewart JC, et al. Negative emotions and 3-year progression of subclinical atherosclerosis. Arch Gen Psychiatry. 2007 Feb;64(2):225-33.
6. Pedersen SS, et al. Type D personality, cardiac events, and impaired quality of life: a review. Eur J Cardiovasc Prev Rehabil. 2003 Aug;10(4):241-8.
7. Kern ML, Friedman HS. Do conscientious individuals live longer? A quantitative review.Health Psychol. 2008 Sep;27(5):505-512.
8. Gottlieb BH, Gillespie AA. Volunteerism, health, and civic engagement among older adults. Can J Aging. 2008 Winter;27(4):399-406.
9. Johnson NJ, Backlund E, Sorlie PD, Loveless CA. Marital status and mortality: the national longitudinal mortality study. Ann Epidemiol. 2000 May;10(4):224-238.
10. Kaplan RM, Kronick RG. Marital status and longevity in the United States population. J Epidemiol Community Health. 2006 Sep;60(9):760-765.
11. Koenig HG, Hays JC, Larson DB, George LK, et al. Does religious attendance prolong survival? A six-year follow-up study of 3,968 older adults. J of Gerontology. 1999 Jul;54(7):M370-6.

How old do people think you are? Are you 60 going on 25? Then you are well on your way to a life of longevity. Perceived age is a term often used by physicians to recognize a patient’s level of health, in which an individual may look younger or older than his or her chronological age. Is there really an internal fountain of youth that radiates through your appearance?

Researchers from the University of Denmark decided to put this idea to the test. The study recruited 1,826 Danish twins (70 years and older) to take physical and cognitive tests. The twins also had their faces photographed. Next, volunteers looked at the photos and determined the subjects’ age based on their appearance. After a seven-year follow up, researchers found that longevity was significantly related to perceived age, as it was more likely that the older-looking twin died first. Additionally, younger-looking individuals had greater physical and mental capacities.

Researchers concluded common genetic factors associated with a younger appearance might also explain the findings. They determined perceived age is a strong indication of aging and longevity.

Reference

Christensen K, Thinggaard M, McGue M, Rexbye H, et al. Perceived age as clinically useful biomarker of ageing: cohort study. BMJ. 2009 Dec 10;339:b5262.

Description

The butterfly-shaped thyroid gland is located in the front of your neck and wraps partially around the windpipe. The gland is responsible for making thyroid hormones that control the metabolism of all cells in your body.

If the thyroid overproduces hormones, you can have a condition called hyperthyroidism. This condition commonly causes symptoms such as a forceful and rapid heart beat, insomnia, sudden weight loss, breathlessness, nervousness, irritability, sweating, and frequent bowel movements.1

Many people can also suffer from different degrees of low or underactive thyroid function, called hypothyroidism. Symptoms of a thyroid gland producing too little thyroid hormone can include a slow metabolism, listlessness, lowered body temperature, weight gain, constipation, muscle soreness, feeling cold, fatigue, depression, high cholesterol and homocysteine, painful joints, dry skin, and hair loss.1-4

There are two types of thyroid hormones: Thyroxine (T4) and Triiodothyronine (T3). T4 is inactive and kept in reserve; T3 is the active hormone. Thyroid hormones control the growth, differentiation, and metabolism of each cell in our body. They also control how fast our body uses the fuel that we consume, particularly carbohydrates and fat.1 This helps to regulate our body temperature and fat percentage. About 80% of thyroid hormone production is T4, the inactive thyroid hormone that is typically held in reserve by the body. T3 makes up only 20% of thyroid hormone production,5 but it is the active hormone that the body uses to function. T4 is converted into T3 when thyroid hormone is needed.

The release of the thyroid hormones is controlled by the thyroid stimulating hormone (TSH), which is produced in the pituitary gland. Low circulating levels of thyroid hormone are detected by the hypothalamus, which then instructs the pituitary to release TSH. When sufficient amounts are released, the hypothalamus communicates with the pituitary to stop or slow down. Because of this complicated feedback loop, high levels of TSH in the blood often mean the pituitary is trying to stimulate thyroid hormone production, but the thyroid gland is not responding. This condition is known as hypothyroidism.

 Benefits of Thyroid

• Regulates temperature, metabolism, and cerebral function
• Increases energy, body temperature, and warmth
• Increases fat breakdown, resulting in decreased weight and lower cholesterol2
• Protects against cardiovascular ailments3,6
• Improves cerebral metabolism
• Supports cognitive function7
• Relieves symptoms of thin sparse hair, dry skin, and brittle nails

Side Effects

The most common side effects from too high a dose of thyroid hormone are heart palpitations,8 increased pulse, excessive sweating, heat intolerance, and nervousness.

Administration

The recommended form of thyroid replacement is an Armour Thyroid Compound, which is a combination of T3 and T4.9 Studies show that a percentage of patients prefer the combination of T4 and T3 over T4 alone.10,11 The combination allows the body to receive the active and inactive form to treat those patients who are not able to properly convert. In contrast, traditional physicians continue to prescribe the synthetic thyroid hormone T4 or Synthroid. Synthroid is only T4 and may not convert to T3.

References

1. Huber MA, Terézhalmy GT. Risk stratification and dental management of the patient with thyroid dysfunction. Quintessence Int. 2008 Feb;39(2):139-50.
2. Asranna A, et al. Dyslipidemia in subclinical hypothyroidism and the effect of thyroxine on lipid profile. Indian J Endocrinol Metab. 2012 Dec;16(Suppl 2):S347-9.
3. Kutluturk F, et al. Changes in metabolic and cardiovascular risk factors before and after treatment in overt hypothyroidism. Med Glas (Zenica). 2013 Aug;10(2):348-53.
4. Rao ML, et al. Low plasma thyroid indices of depressed patients are attenuated by antidepressant drugs and influence treatment outcome. Pharmacopsychiatry. 1996 Sep;29(5):180-6.
5. Sapin R, Schlienger JL. [Thyroxine (T4) and tri-iodothyronine (T3)determinations: techniques and value in the assessment of thyroid function]. Ann Biol Clin (Paris). 2003 Jul-Aug;61(4):411-20.
6. Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med.2001;344(7): 501-509.
7. Bunevicius R, et al. Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism. N Engl J Med. 1999 Feb 11;340(6):424-9.
8. Toft AD. Thyroid hormone replacement – one or two? N Engl J Med. 1999 Feb 11;340(6):469-70.
9. Gaby AR. Sub-laboratory hypothyroidism and the empirical use of Armour thyroid. Altern Med Rev. 2004 Jun; 9(2):157-179.
10. Escobar-Morreale HF, et al. Thyroid hormone replacement therapy in primary hypothyroidism: a randomized trial comparing L-thyroxine plus liothyronine with L-thyroxine alone. Ann Intern Med. 2005 Mar 15;142(6):412-24.
11. Sesmilo G, et al. Serum free triiodothyronine (T3) to free thyroxine (T4) ratio in treated central hypothyroidism compared with primary hypothyroidism and euthyroidism.Endocrinol Nutr. 2011 Jan;58(1):9-15.