Demographic, Healthcare Access, and Dietary Factors Associated With Thyroid Hormone Treatments for Hypothyroidism
Open accessAbstract
Context Clinical guidelines have recommended a trial of liothyronine (LT3) with levothyroxine (LT4) in select patients with hypothyroidism. However, little is known about the real-world use of LT3 and desiccated thyroid extract (DTE) and the characteristics of patients treated with LT3 and DTE. Objectives (1) Determine national trends of new LT4, LT3, and DTE prescriptions in the United States; (2) determine whether sociodemographic, healthcare access, and dietary factors are associated with different thyroid hormone (TH) therapies. Methods Parallel cross-sectional studies were conducted using 2 datasets: (1) a national patient claims dataset (2010-2020) and (2) the National Health and Nutrition Examination Study (NHANES) dataset (1999-2016). Included participants had a diagnosis of primary or subclinical hypothyroidism. Study outcomes included the impact of demographics and healthcare access on differences in the proportion of TH therapies consisting of LT4, LT3, and DTE (patient claims) and differences in dietary behaviors between DTE-treated participants and LT4-treated matched controls (NHANES). Results On an average annual basis, 47 711 adults received at least 1 new TH prescription, with 88.3% receiving LT4 monotherapy, 2.0% receiving LT3 therapy, and 9.4% receiving DTE therapy. The proportion receiving DTE therapy increased from 5.4% in 2010 to 10.2% in 2020. In the analysis between states, high primary care and endocrinology physician densities were associated with in…
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The number of patients on combination therapy has doubled in the last 10 years.
“As a result of these changes in the clinical guidelines, the number of patients on combination therapy has doubled in the last 10 years (36).”
From Emerging Therapies in Hypothyroidism (2024) · cites this paper as [36]
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Self-citation2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism
Wiersinga, W. M., Duntas, L., Fadeyev, V., Nygaard, B., & Vanderpump, M. P. J. (2012) · European Thyroid Journal · doi:10.1159/000339444 · Cited by 427 · see citing works
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Jonklaas, J., Bianco, A. C., Cappola, A. R., Celi, F. S., Fliers, E., Heuer, H., McAninch, E. A., Moeller, L. C., Nygaard, B., Sawka, A. M., et al. (2021) · Thyroid® · doi:10.1089/thy.2020.0720 · Cited by 172 · see citing works
Self-citationLevothyroxine Use in the United States, 2008-2018
Brito, J. P., Ross, J. S., El Kawkgi, O. M., Maraka, S., Deng, Y., Shah, N. D., & Lipska, K. J. (2021) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2021.2686 · Cited by 94 · see citing works
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Self-citationSamuels, M. H., Kolobova, I., Smeraglio, A., Peters, D., Purnell, J. Q., & Schuff, K. G. (2016) · Thyroid · doi:10.1089/thy.2015.0345 · Cited by 87 · see citing works
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Liothyronine and Desiccated Thyroid Extract in the Treatment of Hypothyroidism
Idrees, T., Palmer, S., Maciel, R. M. B., & Bianco, A. C. (2020) · Thyroid® · doi:10.1089/thy.2020.0153 · Cited by 58 · see citing works
Self-citationPrescribing Therapy for Hypothyroidism: Influence of Physician Characteristics
Jonklaas, J., Tefera, E., & Shara, N. (2019) · Thyroid · doi:10.1089/thy.2018.0369 · Cited by 31 · see citing works
Jonklaas, J., Tefera, E., & Shara, N. (2019) · Frontiers in Endocrinology · doi:10.3389/fendo.2019.00031 · Cited by 23 · see citing works
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Emerging Therapies in Hypothyroidism
Bianco, A. C. (2024) · Annual Review of Medicine · doi:10.1146/annurev-med-060622-101007 · Cited by 36 · see citing works
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- Authors
- Ettleson, M. D., Ibarra, S., Wan, W., Peterson, S., Laiteerapong, N., & Bianco, A. C.
- Affiliations
- University of Chicago (US)
- Rush University Medical Center (US)
- Corresponding author
- Ettleson, Matthew D
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2023-06-16
- Volume
- 108
- Issue
- 12
- Pages
- e1614-e1623
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC10655529
- OpenAlex
- W4380992844
- Cited by
- 17
- References
- 12
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 5 · 2023: 5
- FWCI
- 3.49
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Disease
- National Institutes of Health (5T32DK007011-46)
- 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, liothyronine, levothyroxine, desiccated thyroid extract, thyroid hormone replacement, prescribing trends, physician density, health care access, dietary supplements, subclinical hypothyroidism, sociodemographic factors
- MeSH terms
- Adult, Cross-Sectional Studies, Demography, Humans, Hypothyroidism, Nutrition Surveys, Thyroid Hormones, Thyroxine, Triiodothyronine
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