A Cross-Sectional Analysis of Cardiovascular and Bone Health Care Utilization During Treatment With Thyroid Hormone
Open accessAbstract
Context: Combination therapy with levothyroxine and liothyronine (LT4 + LT3) and desiccated thyroid extract (DTE) make up >10% of new thyroid hormone (TH) prescriptions in the United States. Objective: To assess health care 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 database. Materials and Methods: Multi-year cross-sectional analysis examining 5437 participants (≥18 years old) treated with LT4, LT4+LT3, or DTE between 2016 and 2020. Health care 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 health care 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. Results: 5106 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 among DTE/LT4+LT3 vs LT4 users (3.5% vs 7.7%; P = .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. Conclusion: No significant differences in CVD- and BH-related health care utilization were identified between LT4 and DTE/LT4+LT3 users after covariate balancing. Non-MD providers were more likely to prescribe DTE.
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The increased risk of heart failure and strokes in the Korean study was lost when pooled in a meta-analysis with another study from the United States.
“Furthermore, this effect was lost when pooled in a meta-analysis with another study from the United States (80).”
From Risk of Death and Adverse Effects in Patients on Liothyronine: A Multisource Systematic Review and Meta-analysis (2025) · cites this paper as [80]
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- Authors
- Penna, G. C., Bianco, A. C., & Ettleson, M. D.
- Affiliations
- University of Chicago (US)
- Corresponding author
- Ettleson, Matthew D
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2023-10-25
- Volume
- 109
- Issue
- 3
- Pages
- e1143-e1150
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC10876406
- OpenAlex
- W4387934152
- Cited by
- 8
- References
- 15
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3
- FWCI
- 1.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (DK058538, DK077148, DK015070)
- Diabetes Research and Training Center
- University of Chicago (DK020595)
- 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 › Hormonal and reproductive studies
- Keywords
- thyroid hormone replacement, levothyroxine, liothyronine, desiccated thyroid extract, combination thyroid hormone therapy, cardiovascular disease, bone health, atrial fibrillation, heart failure, myocardial infarction, stroke, osteoporosis, fracture, health care utilization, non-physician providers
- MeSH terms
- Adolescent, Cardiovascular Diseases, Cross-Sectional Studies, Humans, Hypothyroidism, Patient Acceptance of Health Care, Thyroid Hormones, Thyroxine, Triiodothyronine, Stroke
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