Real-life practice of thyroid hormone use in hypothyroid and euthyroid patients: A detailed view from the THESIS questionnaire survey in France

Buffet, C; Belin, Lars; Attanasio, Roberto; Nagy, Endre; Papini, Enrico; Perros, Petros; Leenhardt, Laurence

doi:10.1016/j.ando.2021.11.002

Cited by 14 publications

(32 citation statements)

References 37 publications

(42 reference statements)

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“…LT4 as a liquid solution (in Germany, L-Thyroxine Henning Tropfen 30 mL, 100 µg/mL) is less convenient to use (drop counting) and to store (cold storage). This is in line with the reports of the French 28 , Bulgarian 29 , Finnish 30 , Swedish 31 , and Polish 32 surveys, where the majority of the respondents would also prefer LT4 tablets.…”

Section: Discussionsupporting

confidence: 90%

“…Most DGE members who are clinically and academ ically active within the thyroid field are organized within the Thy roid Section of the DGE. In nearly all other THESIS surveys [11,28,[30][31][32][33][34]36], the questionnaire was distributed to all mem bers of an Endocrine Society; limitations also include the virtual patient cases with loss of nuances potentially interfering with the interpretation. Another limitation is that treatment of hypothyroid ism, particularly LT4 prescription, in Germany is initiated mostly by family doctors/general practitioners, who were not represented in this survey.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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A Questionnaire Survey of German Thyroidologists on the Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients: The THESIS (Treatment of Hypothyroidism in Europe by Specialists: An International Survey) Collaborative

Vardarli

Brandenburg

Attanasio

et al. 2022

Exp Clin Endocrinol Diabetes

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Objective To identify the attitudes of German thyroid specialists towards the clinical treatment of hypothyroidism using thyroid hormones (TH). Methods All members of the thyroid section of the German Endocrine Society (DGE) were e-mailed an invitation to participate in a web-based survey about substitution with TH. Results Out of 206 members of the DGE’s thyroid section, 163 (79.1%) responses were received and included in the analysis. Of responding members, 98.6% used levothyroxine (LT4) as the treatment of choice, and 45.4% also prescribed combination therapy with liothyronine (LT4+LT3) in their clinical practice (p<0.001). LT4+LT3 combination was favored in patients with persistent hypothyroidism symptoms despite biochemical euthyroidism on LT4 treatment (p<0.001). Of all respondents, 26.4% never indicated TH therapy for euthyroid patients (p<0.001), while the remainder would consider THs for one or more indications (62.9% for euthyroid infertile women with high anti-thyroid antibody levels (p<0.001), 7.1% in patients with severe hypercholesterolemia, as complementary treatment (p=0.007), and 57.1% in patients with simple goiter (p<0.001)). In conditions that could interfere with LT4 absorption, most respondents still preferred tablets and did not expect a significant difference when switching from one LT4 formulation to another. Conclusion For German thyroid specialists, LT4 is the treatment of choice for hypothyroidism. Combination therapy with LT4+LT3 was considered for patients with persistent symptoms. Even in conditions that could affect bioavailability, German thyroid specialists prefer LT4 tablets rather than other LT4 formulations, such as liquid or soft-gel capsules. The widespread use of thyroid hormone for non-hypothyroid conditions is not consistent with current evidence and needs further study.

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Section: Discussionsupporting

confidence: 90%

Section: Strengths and Limitationsmentioning

confidence: 99%

A Questionnaire Survey of German Thyroidologists on the Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients: The THESIS (Treatment of Hypothyroidism in Europe by Specialists: An International Survey) Collaborative

Vardarli

Brandenburg

Attanasio

et al. 2022

Exp Clin Endocrinol Diabetes

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“…The strength of our survey is an acceptable response rate of 50%, comparable to that of a previous national Belgian survey on thyroid nodule management [ 42 ], and one of the highest of all THESIS surveys (vs. 25.5% in France, 25.8% in Spain, 28.2% in Sweden, 31.2% in Denmark, 39.3% In Italy, 42.4% in Romania) [ 12 , 13 , 16 , 17 , 19 , 20 ], despite the constraints of the ongoing Covid-19 pandemic. Physician surveys performed anonymously can reveal important habits and practices that are not evidence-based, potentially harmful, and identify the extent to which these may need to be prioritized as educational unmet needs that require to be addressed by professional organizations and societies.…”

Section: Discussionmentioning

confidence: 53%

“…In contrast to current evidence, a surprisingly high proportion of Belgian specialists (50%) consider TH treatment in patients with a euthyroid benign goiter growing over time, a rate similar to Bulgarian (55%), Polish (40.9%) and French (40.2%) colleagues [ 14 , 15 , 19 ], but higher than 24.2% of Greek [ 18 ], 21.2% of Spanish [ 17 ],18% of Italians [ 12 ],14% of Swedish [ 20 ] and 12.5% of Danish endocrinologists who responded to this question [ 13 ]. This response may be related to adherence of older endocrinologists to outdated clinical practices, no longer recommended by recent guidelines [ 25 ].…”

Section: Discussionmentioning

confidence: 77%

Use of thyroid hormones in hypothyroid and euthyroid patients: a THESIS* survey of Belgian specialists *THESIS: treatment of hypothyroidism in Europe by specialists: an international survey

et al. 2022

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Background Hypothyroidism is a topic that continues to provoke debate and controversy with regards to specific indications, type of thyroid hormone substitution and efficacy. We investigated the use of thyroid hormones in clinical practice in Belgium, a country where currently only levothyroxine (LT4) tablet formulations are available. Method Members of the Belgian Endocrine Society were invited to respond to an online questionnaire. Results were compared with those from other THESIS surveys. Results Eighty (50%) of the invited 160 individuals, completed the questionnaire. LT4 was the first treatment of choice for all respondents. As secondary choice, some also prescribed liothyronine (LT3) and LT4 + LT3 combinations (2 and 7 respondents, respectively). Besides hypothyroidism, 34 and 50% of respondents used thyroid hormones for infertile euthyroid TPOAb positive women and the treatment of a growing non-toxic goiter, respectively. Had alternative formulations of LT4 to tablets been available (soft gel or liquid L-T4), 2 out of 80 (2.5%) participants would consider them for patients achieving biochemical euthyroidism but remaining symptomatic. This proportion was higher in case of unexplained poor biochemical control of hypothyroidism (13.5%) and in patients with celiac disease or malabsorption or interfering drugs (10%). In symptomatic euthyroid patients, 20% of respondents would try combined LT4 + LT3 treatment. Psychosocial factors were highlighted as the main contributors to persistent symptoms. Conclusions LT4 tablets is the preferred treatment for hypothyroidism in Belgium. A minority of the respondents would try combined LT4 + LT3 in symptomatic but biochemically euthyroid patients. Thyroid hormones are prescribed for euthyroid infertile women with thyroid autoimmunity and patients with non-toxic goiter, a tendency noted in other European countries, despite current evidence of lack of benefit.

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“…Thyroid hormone containing "pep pills" were popular in the past (33) and "thyroid hormone abuse" (consumption of thyroid hormones for weight loss, or to improve energy) continues today occasionally with catastrophic consequences (34). Indeed recent evidence from several European countries suggests that thyroid hormones are still used by a minority of physicians (2.2 -8%) in euthyroid patients for weight loss (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50).…”

Section: Well-being In Euthyroid Subjects Overtreated With Thyroid Ho...mentioning

confidence: 99%

Enhanced Well-Being Associated with Thyrotoxicosis: A Neglected Effect of Thyroid Hormones?

Perros¹

2022

Int J Endocrinol Metab

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Context: Thyrotoxicosis may be associated with a better sense of well-being than in the euthyroid state, though this is not widely recognised. Evidence Acquisition: A comprehensive literature search in PubMed and Google Scholar, was performed to identify studies investigating factors influencing well-being, mood, and psychological features associated with elevated thyroid hormones. Results: Enhanced well-being associated with thyrotoxicosis has been described, although the evidence is observational and anecdotal. Conclusions: Enhanced well-being associated with thyrotoxicosis is probably experienced in a minority of patients and may explain why some seek overtreatment with thyroid hormones and report significant improvement on larger than physiological thyroid hormone replacement regimens. It may also explain why some patients with hyperthyroidism (usually due to Graves’ disease) are reluctant to adhere to anti-thyroid medication.

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Real-life practice of thyroid hormone use in hypothyroid and euthyroid patients: A detailed view from the THESIS questionnaire survey in France

Cited by 14 publications

References 37 publications

A Questionnaire Survey of German Thyroidologists on the Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients: The THESIS (Treatment of Hypothyroidism in Europe by Specialists: An International Survey) Collaborative

A Questionnaire Survey of German Thyroidologists on the Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients: The THESIS (Treatment of Hypothyroidism in Europe by Specialists: An International Survey) Collaborative

Use of thyroid hormones in hypothyroid and euthyroid patients: a THESIS* survey of Belgian specialists *THESIS: treatment of hypothyroidism in Europe by specialists: an international survey

Enhanced Well-Being Associated with Thyrotoxicosis: A Neglected Effect of Thyroid Hormones?

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