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Though an exact dose conversion can be difficult to find, some studies suggest liothyronine sodium has a potency approximately 3-5x that of levothyroxine sodium, so when modifying ratios between these two thyroid hormones, this difference in potency must be considered to avoid supratherapeutic thyroid hormone levels and subsequent adverse effects.11,12 It is also important to note that liothyronine sodium has a more rapid onset of action than levothyroxine sodium, which can impact adverse event profile and impact dosing conversion as well given that switching from once daily levothyroxine to a combination once daily levothyroxine/liothyronine product, even if the dose conversion is correct for the patient, could result in adverse effects due to this different pharmacokinetic profile.13 Assisting Patients through Dose Conversions Dose conversion between various types of thyroid products is challenging
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Fumarate, also an intermediate metabolite of the TCA cycle, conventionally links arginine metabolism to glucose-generated energy metabolism
