Thyroid Stimulating Hormone Stability in Patients Prescribed Synthetic or Desiccated Thyroid Products: A Retrospective Study
Open accessAbstract
The purpose of this retrospective matched-cohort study was to evaluate the stability of thyroid stimulating hormone (TSH) in patients using synthetic compared with desiccated thyroid products. Patients using a thyroid product for the treatment of hypothyroidism were matched 1:1 on age, sex, race/ethnicity, and had a follow-up period of 3 years after the index date. The primary outcome was percent of in-range TSH values. Over 3 years, TSH values in both groups were in-range 79% of the time (P = 0.905). Our results showed no difference in longitudinal TSH stability between desiccated thyroid products and synthetic levothyroxine.
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Replacement doses of synthetic or natural hormones can be titrated to promote normalization of serum free T4 and T3 levels without suppressing serum TSH levels.
“Replacement doses of synthetic or natural hormones can be titrated to promote these changes without suppressing serum TSH levels (43–47).”
From Emerging Therapies in Hypothyroidism (2024) · cites this paper as [47]
The Results report that TSH was within the reference range about 79% of the time in patients prescribed either synthetic levothyroxine or desiccated thyroid. The Outcome Variables section lists TSH measures only; the paper does not establish that doses were titrated to normalize free T4 and T3 without suppressing TSH. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAn undisputed result of combination therapy with synthetic LT4 and LT3 or with desiccated thyroid extract is the normalization of serum free T4 levels and serum T3 levels.
“An undisputed result of combination therapy with synthetic LT4 and LT3 or with DTE is the normalization of the serum free T4 levels (which are relatively higher in LT4-treated patients) and serum T3 levels (which are relatively lower in LT4-treated patients).”
From Emerging Therapies in Hypothyroidism (2024) · cites this paper as [47]
The Outcome Variables and Results sections assess TSH values and their stability in patients prescribed levothyroxine or desiccated thyroid; they do not report normalization of serum free T4 or T3. Searches for free T4, T3, and LT4/LT3 combination therapy found no passage addressing those claims. Page numbers were not available in our copy. (LLM, conf=0.77)
Experimental — accuracy not yet measured
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Cites
Jonklaas, J., Bianco, A. C., Bauer, A. J., Burman, K. D., Cappola, A. R., Celi, F. S., Cooper, D. S., Kim, B. W., Peeters, R. P., Rosenthal, M. S., et al. (2014) · Thyroid® · doi:10.1089/thy.2014.0028 · Cited by 1,928 · cited 1× · see citing works
“Number of TSH laboratories obtained per patient over the 3-year study period (mean, IQR) 3 (3-5) 4 (3-5) 0.”
BackgroundGarber, J. R., Cobin, R. H., Gharib, H., Hennessey, J. V., Klein, I., Mechanick, J. I., Pessah-Pollack, R., Singer, P. A., & Woeber, K. A. (2012) · Endocrine Practice · doi:10.4158/ep12280.gl · Cited by 1,567 · see citing works
Hoang, T. D., Olsen, C. H., Mai, V. Q., Clyde, P. W., & Shakir, M. K. M. (2013) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2012-4107 · Cited by 151 · see citing works
Thyroid Hormone Treatment: New Insights Into an Old Therapy
Cooper, D. S. (1989) · JAMA · doi:10.1001/jama.1989.03420180118042 · Cited by 15 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- The thyroid and you: coping with a common condition. NIH Medline Plus. 2012; 2012(7): 22-23.
Cited by
Sorted by citations
Optimal thyroid hormone replacement
Jonklaas, J. (2022) · Endocrine Reviews · doi:10.1210/endrev/bnab031 · Cited by 89 · see citing works
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
Bianco, A. C., Bao, Y., Flores, O. A., Halpern, R., Le, L. B., Stackland, S., & Frieze, T. W. (2023) · Thyroid · doi:10.1089/thy.2022.0382 · Cited by 16 · see citing works
Heald, A. H., Premawardhana, L., Taylor, P., Okosieme, O., Bangi, T., Devine, H., Livingston, M., Javed, A., Moreno, G. Y. C., Watt, T., et al. (2021) · International Journal of Clinical Practice · doi:10.1111/ijcp.14967 · Cited by 14 · see citing works
Riis, K. R., Larsen, C. B., & Bonnema, S. J. (2024) · Thyroid® · doi:10.1089/thy.2023.0649 · Cited by 10 · see citing works
Fitch, R. M., Mould, D. R., Conoscenti, V., Huang, R., & Harper, D. M. (2025) · Clinical and Translational Science · doi:10.1111/cts.70244 · Cited by 8 · see citing works
Penna, G. C., Bianco, A. C., & Ettleson, M. D. (2024) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgad629 · Cited by 8 · see citing works
Shared Decisionmaking in the Treatment of Hypothyroidism
Bianco, A. C. (2025) · Clinical Endocrinology · doi:10.1111/cen.15228 · Cited by 5 · see citing works
Returning to a Patient-Centered Approach in the Management of Hypothyroidism
Schneiderhan, J. R., & Zick, S. M. (2020) · The Annals of Family Medicine · doi:10.1370/afm.2602 · Cited by 1 · see citing works
Pearce, E. N. (2020) · Clinical Thyroidology · doi:10.1089/ct.2020;32.505-507
(2020) · The Annals of Family Medicine · doi:10.1370/afm.2581
Articles Reviewed by Clinical Thyroidology in 2020
(2020) · Clinical Thyroidology · doi:10.1089/ct.2020;32.580-590
A Brief History of Glandular Therapy: More Than Just Thyroid.
Isaacs, L. L. (2023) · PubMed Central
- Authors
- Kuye, R., Riggs, C., King, J., Heilmann, R., Kurz, D., & Milchak, J.
- Affiliations
- Kaiser Permanente (US)
- Venue
- The Annals of Family Medicine
- Publisher
- Annals of Family Medicine
- Published
- 2020-09
- Volume
- 18
- Issue
- 5
- Pages
- 452-454
- ISSN
- 1544-1709 (ISSN-L)
- 1544-1717
- PMC
- PMC7489980
- OpenAlex
- W3085375661
- Cited by
- 13
- References
- 4
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 4 · 2021: 2 · 2020: 4
- FWCI
- 1.89
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- The Annals of Family Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Keywords
- thyroid-stimulating hormone, desiccated thyroid, levothyroxine, hypothyroidism, thyroid hormone replacement
- MeSH terms
- Aged, Female, Humans, Hypothyroidism, Longitudinal Studies, Male, Middle Aged, Retrospective Studies, Thyroid (USP), Thyrotropin, Thyroxine, Treatment Outcome
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