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

Abstract

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

Use of thyroid hormones in hypothyroid and euthyroid patients: A survey of members of the Endocrine Society of Australia

“…7,8 Like in other countries surveyed, most respondents reported seeing in their practice less than 10% of LT4 treated hypothyroid patients with ongoing symptoms despite a normal TSH, with a higher percentage of such patients in our study seen by those who saw more hypothyroid patients per year. 10,[12][13][14][15][16][17][18][19][20][21][22] Respondents perceived the percentage to be similar or increased compared to 5 years prior, again like other surveyed countries. 10,[12][13][14][15][16][17] This contrasted with most respondents from surveyed countries with high gross national income per capita including Denmark, Ireland and Sweden, that reported seeing more such cases over the past 5 years.…”

“…10,[12][13][14][15][16][17][18][19][20][21][22] Respondents perceived the percentage to be similar or increased compared to 5 years prior, again like other surveyed countries. 10,[12][13][14][15][16][17] This contrasted with most respondents from surveyed countries with high gross national income per capita including Denmark, Ireland and Sweden, that reported seeing more such cases over the past 5 years. [18][19][20]…”

“…These beliefs appear to be consistent with surveys of endocrinologists in other countries across the world suggesting that many endocrinologists do not believe that different preparations are likely to benefit symptomatic patients. 12,13,15,16,18,22,25 A recent international patient questionnaire has highlighted the discord between the views of patients and physicians regarding reasons for dissatisfaction with treatment, 26 but also that dissatisfaction is significantly associated with patients' personality traits. 27 However, many continue to prescribe LT3 + LT4 combination therapy for this group.…”

“…Ireland. 10,[12][13][14][15][16][17][18][19][20][21][22] Eltroxin TM is not considered bioequivalent and therefore is not interchangeable by pharmacists. However, Levoxine TM is bioequivalent and therefore interchangeable with Eutroxsig TM and Oroxine TM .…”

“…34 This number was lower than most surveyed European countries and similar to Latin America, Denmark and the United Kingdom. 10,[12][13][14][15][16][17][18][19][20][21][22] Reassuringly, use of thyroid hormone for euthyroid patients with depression, severe hypercholesterolaemia and unexplained fatigue were not considered by most respondents.…”