open access publication

Article, 2023

Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients: A THESIS questionnaire survey of members of the Irish Endocrine Society

IRISH JOURNAL OF MEDICAL SCIENCE, ISSN 0021-1265, 0021-1265, Volume 192, 5, Pages 2179-2187, 10.1007/s11845-022-03235-z

Contributors

Mustafa, Mohamad 0000-0002-7876-2692 [1] Ali, Elsheikh [1] McGowan, Anne [1] McCabe, Laura [1] Hegedues, Laszlo [2] [3] Attanasio, Roberto 0000-0002-1417-287X [4] Nagy, Endre V. V. [5] Papini, Enrico [6] PERROS, Petros 0000-0001-7320-5574 [7] Moran, Carla (Corresponding author) [8] [9]

Affiliations

  1. [1] Tallaght Univ Hosp, Pharm Dept, Dublin, Ireland
  2. [NORA names: Ireland; Europe, EU; OECD];
  3. [2] Odense Univ Hosp, Dept Endocrinol, Odense, Denmark
  4. [NORA names: Region of Southern Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD];
  5. [3] Odense Univ Hosp, Dept Endocrinol, Odense, Denmark
  6. [NORA names: SDU University of Southern Denmark; University; Denmark; Europe, EU; Nordic; OECD];
  7. [4] Sci Comm Assoc Med Endocrinol, Milan, Italy
  8. [NORA names: Italy; Europe, EU; OECD];
  9. [5] Univ Debrecen, Fac Med, Dept Med, Div Endocrinol, Debrecen, Hungary
  10. [NORA names: Hungary; Europe, EU; OECD];

Abstract

Background Replacement of thyroid hormones (TH) with Levothyroxine (LT4) is the treatment of choice for hypothyroidism, however, there are aspects of treatment where uncertainties exist and practice varies. Factors influencing initiation and choice of TH replacement may impact patient satisfaction, safety, and health care costs. Methods The aim of the study was to examine the attitudes of Irish endocrinologists regarding the treatment of hypothyroid and euthyroid patients with TH. Members of the Irish Endocrine Society (IES) were invited to participate in an online survey. Results Forty-eight invitations were sent, and 39 (81.3%) participants responded. All respondents favoured LT4 tablet therapy for treatment of hypothyroidism, but 20.5% prescribed combination therapy (LT4 and liothyronine), and 13% regularly used desiccated thyroid extract. A significant proportion (51%) might prescribe TH in euthyroid patients; 41% for thyroid auto-antibody positive women seeking pregnancy, 18% for goitre and 5% for unexplained fatigue. Many (38%) consider combination therapy in patients with persistent symptoms. Respondents reported seeing LT4 treated patients with persistent symptomatology more frequently and perceive psychosocial factors and comorbidities to be the most common reasons for such symptoms. Conclusion LT4 tablets are the treatment of choice for hypothyroidism in Ireland. Approximately a third of Irish endocrinologists either regularly use, or would consider, liothyronine for hypothyroid patients. A significant proportion would give TH to euthyroid individuals in specific circumstances. The prescription of TH amongst Irish endocrinologists was generally in keeping with recommended practice, and areas where practice deviated from guidance were typically where evidence was conflicting or insufficient.

Keywords

Clinical practice, Hypothyroidism, Levothyroxine, Survey, Thyroid hormones

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