A cross-sectional analysis of cardiovascular and bone healthcare utilization during treatment with thyroid hormone

• Published in: The journal of clinical endocrinology and metabolism
• Main Authors: Penna, Gustavo C, Bianco, Antonio C, Ettleson, Matthew D
• Format: Journal Article
• Language: English
• Published: United States 25.10.2023
• Subjects: levothyroxine; desiccated thyroid extract; healthcare utilization; hypothyroidism
• ISSN: 1945-7197

Combination therapy with levothyroxine and liothyronine (LT4 + LT3) and desiccated thyroid extract (DTE) make up >10% of new thyroid hormone (TH) prescriptions in the US. To assess healthcare utilization related to cardiovascular disease (CVD) and bone health (BH) events (atrial fibrillation [AF], heart failure [HF], myocardial infarction [MI], stroke, and osteoporosis/fractures [FX]) in participants taking LT4 + LT3 or DTE surveyed in the Medical Expenditure Panel Survey (MEPS) database. Multi-year cross-sectional analysis examining 5,437 participants (≥18 years old) treated with LT4, LT4 + LT3, or DTE between 2016 and 2020. Healthcare utilization was assessed through outpatient, emergency, and hospital visits for AF, HF, MI, stroke, FX, and a composite index. A weighted analysis provided national estimates of healthcare utilization parameters. Utilization was re-analyzed following propensity score-based matching to balance sociodemographic and clinical covariates between treatment groups. Additionally, provider type and specialty data were obtained from visits associated with TH prescriptions. 5,106 participants were treated with LT4 monotherapy, 252 with DTE, and 79 with LT4 + LT3. Prevalence of combined outpatient CVD and BH-related care utilization was lower amongst DTE/LT4 + LT3 vs LT4 users (3.5% vs 7.7%; p = 0.008). There were no differences in emergency/hospital events. After covariate balancing, CVD and BH-related care utilization was similar between groups in outpatient and emergency/hospital settings. LT3 and DTE made up 7.6% of all TH prescriptions. For visits associated with DTE prescriptions, nurse practitioners and alternative medicine professionals were more likely to be identified as the primary provider type. No significant differences in CVD and BH-related healthcare utilization were identified between LT4 and DTE/LT4 + LT3 users after covariate balancing. Non-MD providers were more likely to prescribe DTE.