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. 2023 Oct;192(5):2179-2187.
doi: 10.1007/s11845-022-03235-z. Epub 2022 Dec 8.

Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients: A THESIS questionnaire survey of members of the Irish Endocrine Society

Mohamad Mustafa  1 , Elsheikh Ali  1 , Anne McGowan  1 , Laura McCabe  2 , Laszlo Hegedüs  3 , Roberto Attanasio  4 , Endre V Nagy  5 , Enrico Papini  6 , Petros Perros  7 , Carla Moran  8   9
Affiliations

Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients: A THESIS questionnaire survey of members of the Irish Endocrine Society

Mohamad Mustafa et al. Ir J Med Sci. 2023 Oct.

Abstract

Background: Replacement of thyroid hormones (TH) with Levothyroxine (LT4) is the treatment of choice for hypothyroidism, however, there are aspects of treatment where uncertainties exist and practice varies. Factors influencing initiation and choice of TH replacement may impact patient satisfaction, safety, and health care costs.

Methods: The aim of the study was to examine the attitudes of Irish endocrinologists regarding the treatment of hypothyroid and euthyroid patients with TH. Members of the Irish Endocrine Society (IES) were invited to participate in an online survey.

Results: Forty-eight invitations were sent, and 39 (81.3%) participants responded. All respondents favoured LT4 tablet therapy for treatment of hypothyroidism, but 20.5% prescribed combination therapy (LT4 and liothyronine), and 13% regularly used desiccated thyroid extract. A significant proportion (51%) might prescribe TH in euthyroid patients; 41% for thyroid auto-antibody positive women seeking pregnancy, 18% for goitre and 5% for unexplained fatigue. Many (38%) consider combination therapy in patients with persistent symptoms. Respondents reported seeing LT4 treated patients with persistent symptomatology more frequently and perceive psychosocial factors and comorbidities to be the most common reasons for such symptoms.

Conclusion: LT4 tablets are the treatment of choice for hypothyroidism in Ireland. Approximately a third of Irish endocrinologists either regularly use, or would consider, liothyronine for hypothyroid patients. A significant proportion would give TH to euthyroid individuals in specific circumstances. The prescription of TH amongst Irish endocrinologists was generally in keeping with recommended practice, and areas where practice deviated from guidance were typically where evidence was conflicting or insufficient.

Keywords: Clinical practice; Hypothyroidism; Levothyroxine; Survey; Thyroid hormones.

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Conflict of interest statement

LH, PP, EVN, and EP are scientific board members of and have received consultancy fees from IBSA Biochimique SA.

Figures

Fig. 1
Fig. 1
Forms of thyroid hormone used in clinical practice
Fig. 2
Fig. 2
Use of thyroid hormones in different conditions
Fig. 3
Fig. 3
Indication for using combination LT4 + LT3 therapy
Fig. 4
Fig. 4
Irish endocrinologists’ speculation concerning possible factors explaining persistent symptoms of hypothyroidism despite biochemical euthyroidism in patients treated with LT4
See this image and copyright information in PMC

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