Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients: A 2020 THESIS Questionnaire Survey of Members of the Swedish Endocrine Society

• Published in: Frontiers in endocrinology (Lausanne) Vol. 12; p. 795111
• Main Authors: Planck, Tereza, Lantz, Mikael, Perros, Petros, Papini, Enrico, Attanasio, Roberto, Nagy, Endre V, Hegedüs, Laszlo
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 06.12.2021
• Subjects: Adult; Aged; Clinical Medicine; desiccated thyroid extract (DTE); Drug Therapy, Combination; Endocrinology; Endocrinology and Diabetes; Endokrinologi och diabetes; euthyroidism; Female; Goiter, Nodular - blood; Goiter, Nodular - drug therapy; Goiter, Nodular - epidemiology; Humans; hypothyroidism; Hypothyroidism - blood; Hypothyroidism - drug therapy; Hypothyroidism - epidemiology; Klinisk medicin; levothyroxine; liothyronine; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Middle Aged; Physicians - trends; Societies, Medical - trends; survey; Surveys and Questionnaires; Sweden - epidemiology; Swedish Endocrine Society; Thyroid Hormones - therapeutic use; Thyroxine - therapeutic use; Triiodothyronine - therapeutic use; Young Adult; Sweden; levothyroxine; euthyroidism; hypothyroidism; Swedish Endocrine Society; survey; desiccated thyroid extract (DTE); liothyronine
• ISSN: 1664-2392; 1664-2392
• DOI: 10.3389/fendo.2021.795111

The standard treatment of hypothyroidism is levothyroxine (LT-4). However, there are several controversies regarding treatment of hypothyroid patients. To investigate the Swedish endocrinologists' use of thyroid hormones in hypothyroid and euthyroid individuals. Physician members of the Swedish Endocrine Society (SEF) were invited by e-mail to participate in an online survey investigating this topic. Out of the eligible 411 members, 116 (28.2%) responded. The majority (98.9%) stated that L-T4 is the treatment of choice. However, around 50% also prescribed liothyronine (L-T3) or a combination of L-T4+L-T3 in their practice. Combination therapy was mostly (78.5%) used in patients with persistent hypothyroid symptoms despite biochemical euthyroidism on L-T4 treatment. Most respondents prescribed L-T4 tablets and did not expect any major changes with alternative formulations such as soft-gel capsules or liquid formulations in situations influencing the bioavailability of L-T4. In euthyroid patients, 49.5% replied that treatment with thyroid hormones was never indicated, while 47.3% would consider L-T4 for euthyroid infertile women with high thyroid peroxidase (TPO) antibody levels. The treatment of choice for hypothyroidism in Sweden is L-T4 tablets. Combination therapy with L-T4+L-T3 tablets was considered for patients with persistent symptoms despite biochemical euthyroidism. Soft-gel capsules and liquid solutions of L-T4 were infrequently prescribed. Swedish endocrinologists' deviation from endocrine society guidelines merits further study.