Bioidentical thyroid replacement therapy in practice: Delivering a physiologic T4:T3 ratio for improved patient outcomes with the Listecki-Snyder protocol.
Level 5 - mechanism / opinion, no new human data
Expert opinion and theoretical compounding proposal with no empirical human data in the abstract.
What was done
The paper describes a compounding approach (the Listecki-Snyder protocol) designed to deliver combination levothyroxine (T4) and liothyronine (T3) in an 11:1 ratio. The protocol proposes pairing a commercial T4 product with customized, divided slow-release T3 capsules dosed every 12 hours based on physiologic secretion estimates and oral bioavailability calculations.
What was found
No clinical trial or empirical patient outcome data are reported in the abstract. The authors cite standard pharmacological references stating that human thyroid secretion is approximately an 11:1 T4:T3 ratio compared to commercial desiccated thyroid products (Armour Thyroid, Nature-Throid) which provide a 4.22:1 ratio.
Why it matters
It outlines a compounding rationale for practitioners seeking to deliver a customized physiological ratio of T4 to T3 using slow-release formulations.
Limits
The abstract contains no patient outcome data, pharmacokinetic measurements, sample size, or comparative clinical testing. The recommendation relies entirely on mechanistic reasoning and textbook pharmacology without empirical verification.
Cited by
- supports Nature-Throid is composed of 80% T4 and 20% T3.