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.