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Original paper
Published online: 2021-05-17
Submitted: 2021-04-14
Accepted: 2021-05-16
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Use of thyroid hormones in hypothyroid and euthyroid patients: a THESIS* questionnaire survey of Polish physicians *THESIS: Treatment of Hypothyroidism in Europe by Specialists: an International Survey

Tomasz Bednarczuk, Roberto Attanasio, Laszlo Hegedüs, Endre V. Nagy, Roberto Negro, Enrico Papini, Petros Perros, Marek Ruchała
DOI: 10.5603/EP.a2021.0048
·
Pubmed: 34010443

open access

Ahead of print
Original Paper
Published online: 2021-05-17
Submitted: 2021-04-14
Accepted: 2021-05-16

Abstract

Introduction: Over the past several years new evidence on management of hypothyroidism has emerged and has influenced recommendations from professional bodies. The presentation of hypothyroid patients has also changed and increasingly new cases are diagnosed by indiscriminate screening often identifying cases with minor biochemical disturbances. Little is known about the physician responses and attitudes to this changing landscape. THESIS (Treatment of Hypothyroidism in Europe by Specialists: an International Survey) is a large-scale survey of European physicians who treat patients with hypothyroidism. Here we document current practices of Polish physicians relating to the use of thyroid hormones in hypothyroid and euthyroid patients. Methods: Members of the Polish Society of Endocrinology were invited to participate in the web-based THESIS survey. Results: 423 (54.6% of the 774 invited) completed the survey. The majority of respondents (74.2%) would prescribe thyroid hormones for euthyroid patients for certain indications, such as female infertility with elevated thyroid antibodies (63.4%), simple goiter (40.9%), unexplained fatigue (12.1%), obesity (9.7%), hypercholesterolemia (9.0%) and depression (9.2%). Nearly all physicians (96.0%) declared that the treatment of choice for hypothyroidism is levothyroxine (LT4). However, around one-third (30.3%) were also using LT4 and liothyronine (LT3) combination treatment; LT3 alone was rarely prescribed (1.7%) and none prescribed desiccated thyroid extract. The majority of respondents preferred LT4 tablets. Among alternative formulations, liquid LT4 was most commonly recommended for patients unable to take LT4 in the fasting state (26.0%) and patients with malabsorption (19.9%). Respondents considered prescribing dietary supplements (such as selenium and iodine) in hypothyroid patients with coexisting autoimmune thyroiditis (29.6%) or at the patients’ request (32.2%). LT4 + LT3 combination therapy was used by 32.2% when symptoms persisted notwithstanding normal serum TSH concentration. Psychosocial factors, comorbidities and the burden of chronic disease were considered as the most likely causes for persistent symptoms. Conclusions: Apart from clinical practice recommendations, other factors influence the thyroid hormone therapy patterns. Moreover, certain areas of clinical practice were identified (the use of thyroid hormones in euthyroid subjects and the use of dietary supplements) which are not in accordance with the current evidence.

Abstract

Introduction: Over the past several years new evidence on management of hypothyroidism has emerged and has influenced recommendations from professional bodies. The presentation of hypothyroid patients has also changed and increasingly new cases are diagnosed by indiscriminate screening often identifying cases with minor biochemical disturbances. Little is known about the physician responses and attitudes to this changing landscape. THESIS (Treatment of Hypothyroidism in Europe by Specialists: an International Survey) is a large-scale survey of European physicians who treat patients with hypothyroidism. Here we document current practices of Polish physicians relating to the use of thyroid hormones in hypothyroid and euthyroid patients. Methods: Members of the Polish Society of Endocrinology were invited to participate in the web-based THESIS survey. Results: 423 (54.6% of the 774 invited) completed the survey. The majority of respondents (74.2%) would prescribe thyroid hormones for euthyroid patients for certain indications, such as female infertility with elevated thyroid antibodies (63.4%), simple goiter (40.9%), unexplained fatigue (12.1%), obesity (9.7%), hypercholesterolemia (9.0%) and depression (9.2%). Nearly all physicians (96.0%) declared that the treatment of choice for hypothyroidism is levothyroxine (LT4). However, around one-third (30.3%) were also using LT4 and liothyronine (LT3) combination treatment; LT3 alone was rarely prescribed (1.7%) and none prescribed desiccated thyroid extract. The majority of respondents preferred LT4 tablets. Among alternative formulations, liquid LT4 was most commonly recommended for patients unable to take LT4 in the fasting state (26.0%) and patients with malabsorption (19.9%). Respondents considered prescribing dietary supplements (such as selenium and iodine) in hypothyroid patients with coexisting autoimmune thyroiditis (29.6%) or at the patients’ request (32.2%). LT4 + LT3 combination therapy was used by 32.2% when symptoms persisted notwithstanding normal serum TSH concentration. Psychosocial factors, comorbidities and the burden of chronic disease were considered as the most likely causes for persistent symptoms. Conclusions: Apart from clinical practice recommendations, other factors influence the thyroid hormone therapy patterns. Moreover, certain areas of clinical practice were identified (the use of thyroid hormones in euthyroid subjects and the use of dietary supplements) which are not in accordance with the current evidence.

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Keywords

survey; hypothyroidism; thyroid hormones; levothyroxine; liothyronine; desiccated thyroid extracts; iodine; selenium

About this article
Title

Use of thyroid hormones in hypothyroid and euthyroid patients: a THESIS* questionnaire survey of Polish physicians *THESIS: Treatment of Hypothyroidism in Europe by Specialists: an International Survey

Journal

Endokrynologia Polska

Issue

Ahead of print

Article type

Original paper

Published online

2021-05-17

DOI

10.5603/EP.a2021.0048

Pubmed

34010443

Keywords

survey
hypothyroidism
thyroid hormones
levothyroxine
liothyronine
desiccated thyroid extracts
iodine
selenium

Authors

Tomasz Bednarczuk
Roberto Attanasio
Laszlo Hegedüs
Endre V. Nagy
Roberto Negro
Enrico Papini
Petros Perros
Marek Ruchała

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