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. 2020 Jan;9(1):25-31.
doi: 10.1159/000502057. Epub 2019 Sep 4.

Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients; the 2019 Italian Survey

Roberto Negro  1 , Roberto Attanasio  2 , Endre V Nagy  3 , Enrico Papini  4 , Petros Perros  5 , Laszlo Hegedüs  6
Affiliations

Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients; the 2019 Italian Survey

Roberto Negro et al. Eur Thyroid J. 2020 Jan.

Abstract

Background: The incidence and prevalence of hypothyroidism are increasing and the threshold for the treatment of hypothyroid as well as individuals without evident thyroid disease with thyroid hormone is declining.

Objective: To investigate endocrinologists' use of thyroid hormones in hypothyroid and euthyroid patients in Italy, a country where different formulations of levothyroxine (LT4; tablet, liquid solution and soft-gel capsule) are available on the market.

Methods: Members of the Associazione Medici Endocrinologi (Italian Association of Clinical Endocrinologists) were invited to participate in a web-based survey investigating the topic.

Results: A total of 797 of 2,028 (39.3%) members completed all the sections of the survey; 98.7% declared that the treatment of choice for hypothyroidism is LT4. A significant minority (37.3%) indicated that LT4 may be considered in infertile euthyroid women seeking pregnancy and harbouring positive thyroperoxidase antibodies (TPOAb) and in goitre increasing in size (18.1%). LT4 + LT3 was considered by 43.2% for LT4-replaced patients and normal TSH, if they reported persistent symptoms. High percentages of respondents chose LT4 in a liquid solution or soft-gel capsules when taken together with other drugs interfering with LT4 absorption (81.8%), in patients with a history of celiac disease, malabsorption, lactose intolerance, intolerance to common excipients (96.6%), or unexplained poor biochemical control of hypothyroidism (74.4%), or in patients not able to adhere to ingesting LT4 fasted and/or separated from food/drink (98.9%). In total, 43.6% of responders would use LT4 in a liquid solution or soft-gel capsules for hypothyroid patients with biochemical euthyroidism on LT4, who had persistent symptoms.

Conclusions: The preferred treatment for hypothyroidism is LT4; LT3 + LT4 combination treatment is mainly considered in patients with persistent symptoms. A significant minority would offer LT4 to euthyroid women with positive TPOAb and infertility and to euthyroid patients with progressive simple goitre. Alternative LT4 formulations like liquid solution or soft-gel capsules are largely reserved for specific conditions (interfering drugs, actual or suspected malabsorption, inability to take LT4 in the fasting state, unexplained poor biochemical control of hypothyroidism).

Keywords: European thyroid association; Euthyroidism; Hypothyroidism; Levothyroxine; Survey.

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Conflict of interest statement

R.N. and R.A. have nothing to disclose. E.V.N., E.P., P.P., and L.H. have undertaken consultancy work for IBSA. IBSA had no role in the design of the survey, data analysis, data presentation, data interpretation or writing the manuscript; the authors did not receive remuneration by IBSA.

Figures

Fig. 1
Fig. 1
Use of LT4 in euthyroid subjects (a). Use of LT3 + LT4 in different conditions (b). TPOAb, thyroperoxidase antibodies; LT4, levothyroxine.
See this image and copyright information in PMC

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