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Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients; the 2019 Italian Survey

Open access
Negro, Roberto, Attanasio, Roberto, Nagy, Endre V., Papini, Enrico, Perros, Petros, Hegedüs, Laszlo·2020·European Thyroid Journal
DOI 10.1159/000502057PMC PMC7024857
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Abstract

Background: The incidence and prevalence of hypothyroidism are increasing and the threshold for the treatment of hypothyroid as well as individuals without evident thyroid disease with thyroid hormone is declining. Objective: To investigate endocrinologists’ use of thyroid hormones in hypothyroid and euthyroid patients in Italy, a country where different formulations of levothyroxine (LT4; tablet, liquid solution and soft-gel capsule) are available on the market. Methods: Members of the Associazione Medici Endocrinologi (Italian Association of Clinical Endocrinologists) were invited to participate in a web-based survey investigating the topic. Results: A total of 797 of 2,028 (39.3%) members completed all the sections of the survey; 98.7% declared that the treatment of choice for hypothyroidism is LT4. A significant minority (37.3%) indicated that LT4 may be considered in infertile euthyroid women seeking pregnancy and harbouring positive thyroperoxidase antibodies (TPOAb) and in goitre increasing in size (18.1%). LT4 + LT3 was considered by 43.2% for LT4-replaced patients and normal TSH, if they reported persistent symptoms. High percentages of respondents chose LT4 in a liquid solution or soft-gel capsules when taken together with other drugs interfering with LT4 absorption (81.8%), in patients with a history of celiac disease, malabsorption, lactose intolerance, intolerance to common excipients (96.6%), or unexplained poor biochemical control of hypothyroidism (74.4%), or in patients not able to adhere to ingesting LT4 fasted and/or separated from food/drink (98.9%). In total, 43.6% of responders would use LT4 in a liquid solution or soft-gel capsules for hypothyroid patients with biochemical euthyroidism on LT4, who had persistent symptoms. Conclusions: The preferred treatment for hypothyroidism is LT4; LT3 + LT4 combination treatment is mainly considered in patients with persistent symptoms. A significant minority would offer LT4 to euthyroid women with positive TPOAb and infertility and to euthyroid patients with progressive simple goitre. Alternative LT4 formulations like liquid solution or soft-gel capsules are largely reserved for specific conditions (interfering drugs, actual or suspected malabsorption, inability to take LT4 in the fasting state, unexplained poor biochemical control of hypothyroidism).

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  • High prevalence figures of persistent symptoms are found in countries with a high GDP, whereas the figures are much lower in countries with a low GDP.

    “High prevalence figures are found in countries with a high GDP, whereas the figures are much lower in countries with a low GDP.”

    From T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity (2021) · cites this paper as [33]

    The Introduction (p. 2) mentions ongoing symptoms in patients with hypothyroidism, but gives no prevalence figures by country or GDP. A search of our copy for high- versus low-GDP countries and persistent-symptom prevalence found no comparison; the paper surveys Italian endocrinologists’ treatment practices. (LLM, conf=0.76)

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  • According to most respondents of the THESIS survey, the prevalence of persistent symptoms has increased.

    “The prevalence of persistent symptoms has increased according to most respondents of the THESIS survey (Table 3).”

    From T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity (2021) · cites this paper as [33]

    The Combination Treatment with LT3 + LT4 section (p. 5) reports how respondents would treat patients with persistent symptoms, but not whether respondents thought those symptoms had become more prevalent. Searches for an increase in persistent symptoms and for Table 3 did not find that survey finding in our copy. (LLM, conf=0.76)

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  • Approximately one-third of THESIS survey respondents stated that the prevalence of persistent symptoms increased in the last 5 years.

    “Approximately one-third of respondents stated that the prevalence of persistent symptoms increased in the last 5 years (Table 4).”

    From T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity (2021) · cites this paper as [33]

    The Results (p. 2) give the Italian survey’s respondent count, and the Combination Treatment section (p. 5) discusses respondents’ choices for patients with persistent symptoms. Neither reports that approximately one-third perceived an increase in persistent symptoms over the last five years. Searches for that trend and for Table 4 found no supporting passage in our copy. (LLM, conf=0.76)

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Authors
Negro, R., Attanasio, R., Nagy, E. V., Papini, E., Perros, P., & Hegedüs, L.
Affiliations
  • Ospedale Vito Fazzi (IT)
  • IRCCS Ospedale Galeazzi - Sant'Ambrogio (IT)
  • University of Debrecen (HU)
  • Ospedale Regina Apostolorum (IT)
  • Royal Victoria Infirmary (GB)
  • 6
ORCID
Venue
European Thyroid Journal
Publisher
Bioscientifica
Published
2019-09-04
Volume
9
Issue
1
Pages
25-31
ISSN
  • 2235-0640 (ISSN-L)
  • 2235-0802
DOI
10.1159/000502057
PMC
PMC7024857
OpenAlex
W2972106772
Semantic Scholar
b385a8a3f182515c548f296b2b84f535e936d707
Cited by
52
References
37
Citations by year
2025: 4 · 2024: 11 · 2023: 3 · 2022: 19 · 2021: 10 · 2020: 5
FWCI
6.90
Type
journal article
Language
en
Open access
Licence
Locations
  • European Thyroid Journal (publishedVersion, other-oa)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion, other-oa)
  • University of Debrecen Electronic Archive (University of Debrecen) (submittedVersion)
  • Newcastle University ePrints (Newcastle Univesity)
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, thyroid hormone replacement, euthyroid patients, soft gel capsules, thyroid peroxidase antibodies, goiter, drug interactions, malabsorption, celiac disease, lactose intolerance

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