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. 2025 Nov;103(5):749-756.
doi: 10.1111/cen.70014. Epub 2025 Aug 12.

Thyroid Hormone Treatment for Hypercholesterolemia in Euthyroid Patients: Results From a European Survey of Thyroid Specialists

Juan C Galofré  1   2   3 , Juan J Díez  3   4   5   6 , Roberto Attanasio  7 , Endre V Nagy  8 , Tomasz Bednarczuk  9 , Enrico Papini  10 , Miloš Žarković  11   12 , Roberto Negro  13   14 , Petros Perros  15 , Ersin Akarsu  16 , Maria Alevizaki  17 , Göksun Ayvaz  18 , Eszter Berta  8 , Biljana Nedeljković Beleslin  12 , Miklos Bodor  8 , Anna Maria Borissova  19 , Mihail Boyanov  20   21 , Maria-Cristina Burlacu  22 , Jasmina Ćirić  11   12 , Valentin Fadeyev  23 , Benjamin C T Field  24 , Dagmar Führer  25 , Jiskra Jan  26 , Peter Kopp  27 , Michael Krebs  28 , Michal Kršek  26 , Ivica Lazúrová  29 , Vitaliy Luchytskiy  30 , Francisca Marques Puga  31 , Anne McGowan  32 , Miguel Melo  33 , Saara Metso  34 , Carla Moran  35   36 , Tatyana Morgunova  23 , Dan Alexandru Niculescu  37 , Božidar Perić  38 , Tereza Planck  39 , Eyal Robenshtok  40 , Patrick Olivier Rosselet  41 , Marek Ruchala  42 , Alla Shepelkevich  43 , Mykola Tronko  44 , David Unuane  45   46 , Irfan Vardarli  47   48 , W Edward Visser  49 , Andromachi Vryonidou  50 , Younes R Younes  51 , Laszlo Hegedüs  52
Affiliations

Thyroid Hormone Treatment for Hypercholesterolemia in Euthyroid Patients: Results From a European Survey of Thyroid Specialists

Juan C Galofré et al. Clin Endocrinol (Oxf). 2025 Nov.

Abstract

Objective: A relationship among hypothyroidism and lipid disorders is well established. However, current evidence and guidelines do not support the use of thyroid hormones (TH) in euthyroid patients with hyperlipidaemia as potential harms are considerable. This European survey investigated the use of TH in euthyroid patients with severe hypercholesterolemia as a complementary treatment.

Design: Data were derived from the THESIS (Treatment of Hypothyroidism in Europe by Specialists) project that surveyed TH use. Univariable and multivariable analyses were used to explore associations.

Results: Out of 17,232 invitations, 5695 (33.0%) valid responses were received, and of these, 328 (5.8%) stated that TH are indicated in euthyroid patients with severe hypercholesterolemia. Univariable analyses disclosed significant differences and associations: (a) more non-endocrinologists (8.9%) than endocrinologist (5.4%) used TH (p < 0.001), (b) the number of hypothyroid patients treated per year was inversely related to use of TH (p = 0.024), (c) members of international endocrine/thyroid societies were more likely to use TH than non-members (p < 0.001), (d) significant variations by country and geographical region (p < 0.001), and (e) inverse relationship between gross national income per capita (GNIPC) and TH use (p < 0.001). Multivariable analyses yielded significant associations between use of TH, and male gender, specialty and GNIPC (p < 0.001).

Conclusions: This study suggests that a small but noteworthy minority of European thyroid specialists may be using TH to treat of severe hypercholesterolemia in euthyroid patients. If confirmed, this finding highlights the importance of raising awareness among thyroid specialists, professional societies, and healthcare providers to ensure adherence to evidence-based practices.

Keywords: euthyroidism; hypercholesterolemia; levothyroxine; misuse; treatment.

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