Use of thyroid hormones in hypothyroid and euthyroid patients: a THESIS questionnaire survey of UK endocrinologists
Open accessAbstract
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 comparison to previous international surveys, despite inconsistent evidence of benefit.
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Physician surveys across Europe suggest this guidance is broadly followed.
“Physician surveys across Europe suggest this guidance is broadly followed.189”
From Hypothyroidism (2024) · cites this paper as [189]
The Discussion (Treatment of hypothyroidism; page unavailable) says UK respondents’ TSH-monitoring practices align with NICE and BTA guidance and are consistent with other THESIS surveys. But this supports adherence to a specific aspect of guidance, not the broader claim that guidance is followed across Europe; the Discussion also reports substantial variation between countries in other prescribing practices. (LLM, conf=0.83)
Experimental — accuracy not yet measuredA significant proportion of endocrinologists (51%) are willing to consider prescribing LT3 for these patients.
“a significant proportion of endocrinologists (51%) who are willing to consider prescribing LT3 for these patients (10).”
Hypothyroid subjects on long-term LT4 alone have a 25%-30% increase in cardiovascular and all-cause mortality.
“a 25%–30% increase in cardiovascular and all-cause mortality (10–13)”
Hypothyroid subjects on long-term LT4 alone have a 5% increase in BMI and increased cholesterol.
“a 5% increase in BMI, increased cholesterol”
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- Authors
- Younes, Y. R., Perros, P., Hegedüs, L., Papini, E., Nagy, E. V., Attanasio, R., Negro, R., & Field, B. C. T.
- Affiliations
- East Surrey Hospital (GB)
- Royal Victoria Infirmary (GB)
- Department of Endocrinology and Metabolism Odense University Hospital Odense Denmark
- Ospedale Regina Apostolorum (IT)
- University of Debrecen (HU)
- Scientific Committee Associazione Medici Endocrinologi Milan Italy
- Ospedale Vito Fazzi (IT)
- Corresponding author
- Field, Benjamin C. T.
- ORCID
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2022-09-16
- Volume
- 98
- Issue
- 2
- Pages
- 238-248
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- PMC
- PMC10087612
- OpenAlex
- W4292166142
- Cited by
- 19
- References
- 35
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 7 · 2023: 6 · 2022: 1
- FWCI
- 3.34
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Endocrinology (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, cc-by-nc-nd)
- University of Debrecen Electronic Archive (University of Debrecen) (submittedVersion, cc-by-nc-nd)
- Newcastle University ePrints (Newcastle Univesity) (cc-by-nc-nd)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- hypothyroidism, levothyroxine, liothyronine, desiccated thyroid extract, euthyroid patients, thyroid hormone replacement, goiter, female infertility, thyroid peroxidase antibodies, treatment dissatisfaction
- MeSH terms
- Endocrinologists, Aged, Female, Goiter, Goiter, Nodular, United Kingdom, Humans, Hypothyroidism, Infertility, Female, Middle Aged, Surveys and Questionnaires, Thyroid Hormones, Thyrotropin, Thyroxine, Triiodothyronine
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