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Use of thyroid hormones in hypothyroid and euthyroid patients: A THESIS questionnaire survey of UK endocrinologists

Lookup NU author(s): Dr Petros PerrosORCiD

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).

Abstract

© 2022 The Authors. Clinical Endocrinology published by John Wiley & Sons Ltd. Objective: Management of hypothyroidism is controversial because of medication cost pressures and scientific uncertainty on how to address treatment dissatisfaction experienced by some patients. The objective was to investigate the experience and preferences of UK endocrinologists in use of thyroid hormones. Design: Web-based survey. Patients: UK endocrinologists were invited to participate. Measurements: Responses to questionnaire. Results: The response rate was 21% (272/1295). While levothyroxine monotherapy is regarded as the treatment of choice for hypothyroidism, 51% of respondents stated that combined treatment with levothyroxine and liothyronine could be considered for levothyroxine-treated patients whose symptoms persist despite normalisation of serum thyroid stimulating hormone (TSH) concentration. However, only 40% are currently prescribing such treatment, and just 23% would consider taking it themselves. A small minority prescribe desiccated thyroid extract, and those most likely to do so are aged over 60 years. Most respondents stated that they have no influence over brand or formulation of levothyroxine dispensed to their patients and expect no major differences in efficacy between different formulations. A total of 9% would prescribe levothyroxine for euthyroid enlarging goitre, and 29% for euthyroid female infertility with high titre thyroid peroxidase antibodies, despite recent trials finding no benefit. Conclusions: UK endocrine practice in management of hypothyroidism is broadly in line with international guidance. However, a minority of respondents would consider thyroid hormone supplementation in euthyroid individuals for female infertility, enlarging goitre, and other indications in which evidence of efficacy is lacking. Willingness to consider prescribing combined levothyroxine and liothyronine, for hypothyroid symptoms which persist despite normalised TSH, has increased in comparison to previous international surveys, despite inconsistent evidence of benefit.

Publication metadata

Author(s): Younes YR, Perros P, Hegedus L, Papini E, Nagy EV, Attanasio R, Negro R, Field BCT

Publication type: Article

Publication status: Published

Journal: Clinical Endocrinology

Year: 2023

Volume: 98

Issue: 2

Pages: 238-248

Print publication date: 01/02/2023

Online publication date: 16/08/2022

Acceptance date: 02/08/2022

Date deposited: 06/10/2022

ISSN (print): 0300-0664

ISSN (electronic): 1365-2265

Publisher: John Wiley and Sons Inc.

URL: https://doi.org/10.1111/cen.14812

DOI: 10.1111/cen.14812

PubMed id: 35975405

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