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Desiccated thyroid extract (DTE) combined with levothyroxine (L-T4) is a combination hormonal therapy being investigated for thyroid-stimulating hormone (TSH) suppression in patients with intermediate-to-high risk differentiated thyroid cancer (DTC) following surgery. DTE is a porcine-derived preparation containing both thyroxine (T4) and triiodothyronine (T3) in an approximate 4:1 ratio, which closely mimics the physiological secretion of the human thyroid gland. Levothyroxine is a synthetic form of T4. This combination approach aims to address the limitations of standard L-T4 monotherapy, such as impaired T4-to-T3 conversion caused by deiodinase 2 (DIO2) polymorphisms and the non-physiological hormone ratios of monotherapy. By providing exogenous T3 directly, the combination bypasses deiodinase defects to achieve tighter TSH control and potentially mitigate side effects like atrial fibrillation and osteoporosis associated with TSH over-suppression. The therapy is currently being evaluated in the DELTA trial led by West China Hospital.
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