Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients: A Thesis* Questionnaire Survey of Romanian Physicians *Thesis: Treatment of Hypothyroidism in Europe by Specialists: an International Survey

Abstract

Objective: Romania has no national guidelines for hypothyroidism treatment, nor are there any recommendations from national societies to adhere to international guidelines. Our aim was to identify the attitudes of Romanian physicians relating to hypothyroidism treatment focusing on available formulations of levothyroxine (LT4).

Methods: All 748 members of the Romanian Society of Endocrinology were invited to participate in a web-based survey. A total of 316 (42.24%) members responded, of whom 222 (70.2%) completed all questions.

Results: Half of the respondents recommended LT4 treatment in euthyroid patients, from 3.6% in euthyroid patients with obesity to 36.4% in euthyroid females with infertility associated with high levels of thyroid antibodies. LT4 was considered the preferred treatment for hypothyroidism (compared to combination treatment of LT4 with LT3 or LT3 alone) by 98.6% of respondents. LT4 in liquid solution was preferred over tablets if malabsorption is suspected (56.5% vs. 27.3%), for patients with unexplained poor biochemical control (52.5% vs. 22.9%) and for patients not able to adhere to ingesting LT4 fasted (74.0% vs. 9.8%). The most and least probable explanations for persistent symptoms in patients with hypothyroidism who achieve a normal TSH under medication were "psychosocial factors" and "burden of having to take medication", respectively.

Conclusion: A significant proportion of Romanian physicians would use LT4 in some groups of euthyroid patients, contrary to current evidence. The preferred treatment for hypothyroidism was LT4. Alternative LT4 formulations (liquid solution) are considered in specific clinical conditions. Diversification of available thyroid hormone formulations was readily incorporated into everyday practice.

Keywords: Romania; THESIS; hypothyroidism; survey.

Figure 1.

Use of LT4 for euthyroid subjects with different clinical scenarios based on respondents’ age (left image) (from left to right: 23-30, 31-40, 41-50, 51-60, >60 years of age, aggregate) or respondents’ years of clinical practice (right image) (from left to right: 0-10, 11-20, 21-30, 31-40, >40, aggregate). “Yes” – black bars, “No” – light grey bars, “No response” – dark grey bars.

Figure 2.

Possible explanations for persistent symptoms in hypothyroid patients who achieved normal TSH under LT4 treatment. From dark grey to light gray the bars stand for “strongly disagree”, “disagree”, “neutral”, “agree” and “strongly agree”.