Natural desiccated thyroid for the treatment of hypothyroidism?
Open accessAbstract
Primary hypothyroidism affects about 3% of the general population in Europe. Early treatments in the late 19 th Century involved subcutaneous as well as oral administration of thyroid extract. Until the early 1970s, the majority of people across the world with hypothyroidism were treated with natural desiccated thyroid (NDT) (derived from pig thyroid glands) in various formulations, with the majority of people since then being treated with levothyroxine (L-thyroxine). There is emerging evidence that may account for the efficacy of liothyronine (NDT contains a mixture of levothyroxine and liothyronine) in people who are symptomatically unresponsive to levothyroxine. While this is a highly selected group of people, the severity and chronicity of their symptoms and the fact that many patients have found their symptoms to be alleviated, can be viewed as valid evidence for the potential benefit of NDT when given after careful consideration of other differential diagnoses and other treatment options.
AI snapshot
Written from the paper’s full text.
TL;DR
This review argues that natural desiccated thyroid (NDT) may benefit a highly selected group of patients with levothyroxine-unresponsive hypothyroidism, despite lack of guideline endorsement and limited randomized evidence. It summarizes historical use, prescribing trends, prior case-series and RCT findings, and patient-reported experiences.
Key findings
- Primary hypothyroidism affects about 3% of the general population in Europe, and up to 10% of treated hypothyroid individuals report impaired quality of life despite free thyroxine and TSH levels within reference range.
- NDT was the preferred therapy from the early 1890s through the mid-1970s; in 1965, approximately 4 of every 5 thyroid hormone prescriptions in the USA were for natural thyroid preparations. After the 1985 U.S. Pharmacopeia standard revision from iodine content to T3/T4 content, levothyroxine largely replaced NDT.
- In England, 436 individuals were prescribed NDT by GPs in 2018/2019 across 382 general practices, and an estimated 337 individuals were prescribed NDT in general practice in 2022; USA NDT prescribing is at least 10 times more prevalent than in the UK. Average NDT cost was £207/prescription in 2016, rising 220% to £440 in 2022, while total annual prescriptions fell 44% from 4,257 in 2016 to 2,384 in 2022.
- In the Hoang et al. RCT, NDT did not significantly improve quality of life, but was associated with some weight loss and 48.6% of participants preferred NDT over levothyroxine; those who preferred NDT lost 4 lb and had significantly better subjective symptoms on the general health questionnaire-12 and a bespoke thyroid symptom questionnaire. A subsequent study found that the 1/3 most symptomatic patients on levothyroxine strongly preferred treatment containing liothyronine (levothyroxine+liothyronine and NDT).
Methods
- Narrative review/commentary, not a systematic review or primary study; no formal search strategy, inclusion criteria, or meta-analysis is described.
- It synthesizes historical accounts, prescribing and cost data from England, prior case-series findings, two randomized double-blind controlled trials comparing NDT with levothyroxine, guideline positions, and patient narratives.
- Main analysis is a narrative synthesis of existing evidence and clinical experience, including tables of available NDT preparations and patient-reported experiences.
Limitations
- The paper states that large well-designed RCTs are needed to identify which individuals could benefit from NDT compared with levothyroxine monotherapy.
- The paper acknowledges that the apparent benefit is in a highly selected group of levothyroxine-unresponsive patients, that NDT does not perfectly match the physiological LT4:LT3 ratio, and that its precise composition varies slightly over time as a biological preparation.
- Evident from the text: the review relies heavily on a prior case series and patient narratives, with no new primary data, no systematic evidence appraisal, and potential selection and reporting bias in the positive patient experiences presented.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
8 of 21 cited sources checked · 3 supported · 0 flagged · accuracy not yet measured
- Premisecitation
Up to 10% of treated diagnosed hypothyroid individuals report impaired quality of life despite achieving serum free thyroxine and thyroid stimulating hormone (TSH) levels within the laboratory reference range.
“It is reported that up to 10% of treated diagnosed hypothyroid individuals report impaired quality of life, despite achieving serum free thyroxine and thyroid stimulating hormone (TSH) levels within the laboratory reference range”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [5] Pearce, 2013, ETA guideline: management of subclinical hypothyroidism, Eur Thyroid J source
In “How to Treat?” (p. 10), the guideline says some treated patients with subclinical hypothyroidism have no improvement in symptoms and recommends adjusting treatment to bring TSH into the reference range. It does not report that up to 10% have impaired quality of life despite both free thyroxine and TSH being within laboratory reference ranges. (LLM, conf=0.79)
Experimental — accuracy not yet measured
- Interpretationcitation
Significant benefit is experienced by people who, by nature of their lack of response to levothyroxine, have been treated with NDT.
“Significant benefit is experienced by people who by nature of their lack or response to levothyroxine have been treated with NDT.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [16] Heald, 2021, Is there a role for natural desiccated thyroid in the treatment of levothyroxine unresponsive hypothyroidism? Results from a consecutive case series, Int J Clin Pract source
- Rests on an assumption: The symptom and quality-of-life improvements observed in patients on NDT are attributable to NDT itself rather than to placebo effect, regression to the mean, or other concurrent factors.
- Rests on an assumption: The findings from the highly selected case series can be generalized to the broader population of levothyroxine-unresponsive hypothyroid patients.
- Findingcitation
In the authors' recent case series, significant benefit was experienced by people who were treated with NDT because of their lack of response to levothyroxine.
“In our recent case series (16) it was reported that significant benefit was experienced by people who by nature of their lack or response to levothyroxine were treated with NDT.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [16] Heald, 2021, Is there a role for natural desiccated thyroid in the treatment of levothyroxine unresponsive hypothyroidism? Results from a consecutive case series, Int J Clin Pract source
- Interpretationown data
The reduction in symptoms and improvement in quality of life, as evidenced in the authors' study by the change in scores on the ThyPro and EQ5D5L scales, provide objective evidence of benefit.
“The reduction it symptoms and improvement in quality of life, as evidenced in our study by the change in scores on the ThyPro and EQ5D5L (29, 30) scales provide objective evidence of benefit”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [29] Rabin, 2001, EQ-5D: a measure of health status from the EuroQoL Group, Ann Med source
The EQ-5D self-report section describes an instrument for rating health-related quality of life. The EQ-5D self-classifier section shows three response levels per dimension, not the cited EQ-5D-5L version. This citation is attached to the scales, so the citing authors’ reported improvement is not being judged as a finding of this source. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [30]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Rests on an assumption: The symptom and quality-of-life improvements observed in patients on NDT are attributable to NDT itself rather than to placebo effect, regression to the mean, or other concurrent factors.
- Findingown data
A significant associated benefit, as measured by EQ-5D-5L utility scores and ThyPRO scores, was seen in people on NDT.
“Notably a significant associated benefit, as measured both by EQ-5D-5L utility scores and ThyPRO scores was seen in people on NDT, as measured both by the EQ-5D-5L and ThyPRO ratings ( Figure 1 ).”
Quote in the paperSubstantial claim
- Findingcitation
In the RCT by Hoang et al., NDT therapy did not result in a significant improvement in quality of life.
“In the RCT reported by Hoang et al. (19), NDT therapy did not result in a significant improvement in quality of life.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] Hoang, 2013, Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study, J Clin Endocrinol Metab source
- Premisecitation
The 1985 revision of the U.S. Pharmacopeia standard from iodine content to L-liothyronine (T3)/L-thyroxine (T4) content resulted in stable potency of desiccated thyroid preparations.
“It was not until 1985 that the revision of the U.S. Pharmacopeia standard from iodine content to L-liothyronine Tt3)/L-thyroxine (T4) content resulted in stable potency after earlier concerns (8)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [8] Mangieri, 1970, Potency of United States Pharmacopeia dessicated thyroid tablets as determined by the antigoitrogenic assay in rats, J Clin Endocrinol Metab source
- Premisecitation
There is emerging evidence that may account for the efficacy of liothyronine in people who are symptomatically unresponsive to levothyroxine.
“There is emerging evidence that may account for the efficacy of liothyronine (NDT contains a mixture of levothyroxine and liothyronine) in people who are symptomatically unresponsive to levothyroxine (19).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [19] Hoang, 2013, Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study, J Clin Endocrinol Metab source
- Interpretationcitation
DIO2 polymorphisms may represent a pharmacogenetic component in those who are non-responsive to levothyroxine.
“This may represent a pharmacogenetic component in those who are non-responsive to levothyroxine (22).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [22] Panicker, 2009, Common variation in the DIO2 gene predicts baseline psychological well-being and response to combination thyroxine plus triiodothyronine therapy in hypothyroid patients, J Clin Endocrinol Metab source
- Premisecitation
Polymorphisms in the genetic coding of the deiodinase-2 (DIO2) enzyme, present in 13% of the population, have the potential to reduce T3 levels in many tissues, including the brain, without affecting serum levels.
“Polymorphisms in the genetic coding of the deiodinase-2 (DIO2) enzyme, present in 13% of the population, have the potential to reduce T3 levels in many tissues, including the brain, without affecting serum levels (21).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [21] Castagna, 2017, DIO2 thr92Ala reduces deiodinase-2 activity and serum-T3 levels in thyroid-deficient patients, J Clin Endocrinol Metab source
- Premisecitation
Since 1985, the formulation of clinician-prescribed NDT has been considered reliable.
“However, it should again be pointed out that since 1985 the formulation of clinician prescribed NDT has been considered reliable (8), contrary to what is believed by some to be the case.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [8] Mangieri, 1970, Potency of United States Pharmacopeia dessicated thyroid tablets as determined by the antigoitrogenic assay in rats, J Clin Endocrinol Metab source
- Premisecitation
Thyrotoxic symptoms and some cases of thyroid storm have been reported during the inappropriate use of thyroid hormone extracts including NDT.
“It should be pointed out that thyrotoxic symptoms and some cases of thyroid storm have been reported during the inappropriate use of thyroid hormone extracts including NDT (18).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [18] Jha, 2012, Thyroid storm due to inappropriate administration of a compounded thyroid hormone preparation successfully treated with plasmapheresis, Thyroid. source
- Interpretationreasoning
The severity and chronicity of symptoms in this highly selected group, and the fact that many patients have found their symptoms to be alleviated, can be viewed as valid evidence for the potential benefit of NDT when given after careful consideration of other differential diagnoses and other treatment options.
“While this is a highly selected group of people, the severity and chronicity of their symptoms and the fact that many patients have found their symptoms to be alleviated, can be viewed as valid evidence for the potential benefit of NDT when given after careful consideration of other differential diagnoses and other treatment options.”
Quote in the paperNot a substantial claim- Rests on an assumption: The symptom and quality-of-life improvements observed in patients on NDT are attributable to NDT itself rather than to placebo effect, regression to the mean, or other concurrent factors.
- Rests on an assumption: The findings from the highly selected case series can be generalized to the broader population of levothyroxine-unresponsive hypothyroid patients.
- Classified as probably not a substantial claim. 6
- May combine two claims. 6
Classified as probably not a substantial claim. May combine two claims.
PremisecitationA proportion of people with hypothyroidism who are seemingly treatment resistant are prescribed liothyronine, usually in addition to levothyroxine and occasionally as monotherapy, but some prefer NDT.
“A proportion of people with hypothyroidism who are seemingly treatment resistant as described, are prescribed liothyronine (L-tri-iodothyronine), usually in addition to levothyroxine and occasionally as monotherapy but some do prefer NDT (6).”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [6] McAninch, 2016, The history and future of treatment of hypothyroidism, Ann Intern Med source
The “Euthyroid” Yet Symptomatic Patient section describes residual symptoms, studies of levothyroxine–liothyronine combination therapy, and patients who preferred desiccated thyroid. Changing Themes in Treatment Guidelines says combination therapy may be considered for some symptomatic patients. The paper does not establish what proportion are prescribed liothyronine, that it is usually prescribed in combination, or that current patients occasionally receive it as monotherapy; its discussion of liothyronine monotherapy concerns early trials. (LLM, conf=0.86)
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationNDT preparations contain a mixture of levothyroxine and liothyronine in a fixed ratio, although this ratio varies slightly between batches.
“They contain a mixture of levothyroxine and liothyronine in a fixed ratio (although this ratio does vary slightly between batches).”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [10] Mitchell, 2009, Trends in thyroid hormone prescribing and consumption in the UK, BMC Public Health source
The Background (page unavailable) identifies desiccated porcine thyroid as a preparation and discusses its T3 content relative to human thyroid, alongside T3/T4 replacement. It does not state that NDT has a fixed levothyroxine-to-liothyronine ratio or that the ratio varies between batches. (LLM, conf=0.82)
Experimental — accuracy not yet measured
Classified as probably not a substantial claim.
FindingcitationThe majority of patients in the case series found their symptoms to be alleviated.
“The authors noted that the majority of patients found these symptoms to be alleviated and suggested that this could be viewed as robust evidence for the potential benefit of NDT.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [16] Heald, 2021, Is there a role for natural desiccated thyroid in the treatment of levothyroxine unresponsive hypothyroidism? Results from a consecutive case series, Int J Clin Pract source
The Discussion and Conclusion say that the majority of patients found their symptoms alleviated. They describe this as supportive evidence for a potential benefit of NDT, not robust evidence; the Strengths and limitations section also emphasizes the lack of a comparator group or blinding and the possibility of a placebo effect. (LLM, conf=0.90)
Experimental — accuracy not yet measured
May combine two claims.
FindingcitationIn a subsequent study by the same group, subgroup analyses of the one-third most symptomatic patients on levothyroxine revealed strong preference for treatment containing liothyronine (levothyroxine+liothyronine and NDT), which reduced symptomatology and improved performance on several scales.
“In a subsequent study by the same group involving a comparison between levothyroxine, levothyroxine+ liothyronine and NDT, subgroup analyses of the 1/3 most symptomatic patients on levothyroxine revealed strong preference for treatment containing liothyronine (levothyroxine+liothyronine and NDT), which reduced symptomatology and improved performance on several scales (25).”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [25] Shakir, 2021, Comparative effectiveness of levothyroxine, desiccated thyroid extract, and levothyroxine+Liothyronine in hypothyroidism, J Clin Endocrinol Metab source
May combine two claims.
FindingcitationIn the RCT by Hoang et al., NDT was associated with a degree of weight loss and nearly half (48.6%) of study participants expressed preference for NDT over levothyroxine.
“However NDT was associated with a degree of weight loss and nearly half (48.6%) of the study participants expressed preference for NDT over levothyroxine. (48.6%)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] Hoang, 2013, Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study, J Clin Endocrinol Metab source
May combine two claims.
FindingcitationIn the RCT by Hoang et al., those who preferred NDT lost 4 lb during treatment, and their subjective symptoms were significantly better while taking DTE as measured by the General Health Questionnaire-12 and a bespoke thyroid symptom questionnaire.
“Those who preferred NDT lost 4lb during the treatment, and their subjective symptoms were significantly better while taking DTE as measured by the general health questionnaire-12 (23) and a bespoke thyroid symptom questionnaire (24).”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [19] Hoang, 2013, Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study, J Clin Endocrinol Metab source
- cites [23] McDowell, 1996
Not checked in the free run.
- cites [24] Clyde, 2003, Combined levothyroxine plus liothyronine compared with levothyroxine alone in primary hypothyroidism: a randomized controlled trial, JAMA source
Probably not a substantial claim: may not pass S2 (checkable), S4 (based).
Interpretationnone givenNDT can offer a lifeline to people who may for many years have experienced debilitating symptoms of levothyroxine unresponsiveness and who are not able to access combination prescribed LT4 and LT3.
“Nevertheless, while NDT is not perfect in terms of the ratio of liothyronine to levothyroxine it can offer a ‘lifeline’ to people who may for many years have experienced debilitating symptoms of levothyroxine unresponsiveness who are not able to access combination prescribed LT4 and LT3.”
Quote in the paperNot a substantial claim- Rests on an assumption: The non-physiological ratio of liothyronine to levothyroxine in NDT does not prevent clinically meaningful benefit.
May combine two claims.
PremisecitationIncreased free T4 levels, as seen with levothyroxine therapy alone, appear to inhibit local deiodination except in the pituitary, so that levothyroxine monotherapy may result in TSH inhibition while reducing thyroid bioavailability in other tissues.
“Increased free T4 levels, as seen with levothyroxine therapy alone, appear to inhibit local deiodination except in the pituitary, so that levothyroxine monotherapy may result in TSH (20) inhibition while reducing thyroid bioavailabity in other tissues.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [20] Christoffolete, 2006, Atypical expression of type 2 iodothyronine deiodinase in thyrotrophs explains the thyroxine-mediated pituitary thyrotropin feedback mechanism, Endocrinology source
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).
Interpretationnone givenIndividual descriptions of the response to NDT in relation to improvement in quality of life and reduction in symptoms have validity in a clinical context.
“Individual descriptions of the response to NDT in relation to improvement in quality of life and reduction in symptoms ( Table 2 ) have validity in a clinical context.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S4 (based).
Interpretationnone givenThe potential beneficial effects of combination treatment with levothyroxine and liothyronine cannot be compared to treatment with NDT in hypothyroid patients because NDT contains a slightly different proportion of LT3 and LT4 versus the physiological ratio.
“The potential beneficial effects of combination treatment with levothyroxine and liothyronine (with an optimum ratio of LT4 to LT3) cannot be compared to treatment with NDT in hypothyroid patients; the latter containing a slightly different proportion of LT3 and LT4 vs the physiological ratio.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
InterpretationreasoningThe precise composition of NDT thyroid does vary very slightly over time, given that it is a biological preparation.
“Nevertheless the precise composition of NDT thyroid does very slightly over time, given that this is a biological preparation.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
The symptom and quality-of-life improvements observed in patients on NDT are attributable to NDT itself rather than to placebo effect, regression to the mean, or other concurrent factors.
“The authors noted that the majority of patients found these symptoms to be alleviated and suggested that this could be viewed as robust evidence for the potential benefit of NDT.”
The paper relies on this without support.
The findings from the highly selected case series can be generalized to the broader population of levothyroxine-unresponsive hypothyroid patients.
“While this is a highly selected group of people, the severity and chronicity of their symptoms and the fact that many patients have found their symptoms to be alleviated, can be viewed as valid evidence for the potential benefit of NDT when given after careful consideration of other differential diagnoses and other treatment options.”
The paper relies on this without support.
Many people across the world take NDT and report great benefit.
“Current guidelines do not endorse the use of NDT but many people across the world do take it and report great benefit.”
The paper relies on this without support.
The non-physiological ratio of liothyronine to levothyroxine in NDT does not prevent clinically meaningful benefit.
“Nevertheless, while NDT is not perfect in terms of the ratio of liothyronine to levothyroxine it can offer a ‘lifeline’ to people who may for many years have experienced debilitating symptoms of levothyroxine unresponsiveness who are not able to access combination prescribed LT4 and LT3.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Europe availability heading conflicts with table entry
MinorThe table is described as listing preparations available for prescription in Europe, but it labels Natural thyroid as available in the USA only.
“Table: Table 1 The NDT preparations currently available for prescription in Europe.”
“| Natural thyroid (65mg grain) | 9mcg | 38 mcg | USA |”
Cites
EQ-SD: a measure of health status from the EuroQol Group
Rabin, R., & Charro, F. D. (2001) · Annals of Medicine · doi:10.3109/07853890109002087 · Cited by 5,613 · see citing works
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
“The American Thyroid Association concluded in 2014 that there is a role for long-term outcome clinical trials testing combination therapy or thyroid extracts (26).”
BackgroundGlobal epidemiology of hyperthyroidism and hypothyroidism
Taylor, P. N., Albrecht, D., Scholz, A., Gutierrez-Buey, G., Lazarus, J. H., Dayan, C. M., & Okosieme, O. E. (2018) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2018.18 · Cited by 1,552 · see citing works
Self-citation2013 ETA Guideline: Management of Subclinical Hypothyroidism
Pearce, S. H. S., Brabant, G., Duntas, L. H., Monzani, F., Peeters, R. P., Razvi, S., & Wemeau, J.-L. (2013) · European Thyroid Journal · doi:10.1159/000356507 · Cited by 877 · see citing works
Saravanan, P., Chau, W. ‐., Roberts, N., Vedhara, K., Greenwood, R., & Dayan, C. M. (2002) · Clinical Endocrinology · doi:10.1046/j.1365-2265.2002.01654.x · Cited by 514 · see citing works
Self-citationPanicker, V., Saravanan, P., Vaidya, B., Evans, J., Hattersley, A. T., Frayling, T. M., & Dayan, C. M. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-1301 · Cited by 327 · see citing works
Self-citationMurray, G. R. (1891) · BMJ · doi:10.1136/bmj.2.1606.796 · Cited by 233 · see citing works
Clyde, P. W., Harari, A. E., Getka, E. J., & Shakir, K. M. M. (2003) · JAMA · doi:10.1001/jama.290.22.2952 · Cited by 195 · 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
DIO2 Thr92Ala Reduces Deiodinase-2 Activity and Serum-T3 Levels in Thyroid-Deficient Patients
Castagna, M. G., Dentice, M., Cantara, S., Ambrosio, R., Maino, F., Porcelli, T., Marzocchi, C., Garbi, C., Pacini, F., & Salvatore, D. (2017) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2016-2587 · Cited by 151 · see citing works
Christoffolete, M. A., Ribeiro, R., Singru, P., Fekete, C., da Silva, W. S., Gordon, D. F., Huang, S. A., Crescenzi, A., Harney, J. W., Ridgway, E. C., et al. (2006) · Endocrinology · doi:10.1210/en.2005-1300 · Cited by 118 · see citing works
The history and future of treatment of hypothyroidism
McAninch, E. A., & Bianco, A. C. (2016) · Annals of Internal Medicine · doi:10.7326/m15-1799 · Cited by 118 · see citing works
Watt, T., Bjorner, J. B., Groenvold, M., Rasmussen, Å. K., Bonnema, S. J., Hegedüs, L., & Feldt-Rasmussen, U. (2009) · Quality of Life Research · doi:10.1007/s11136-009-9460-8 · Cited by 112 · see citing works
Smith, R. N., Taylor, S. A., & Massey, J. C. (1970) · BMJ · doi:10.1136/bmj.4.5728.145 · Cited by 106 · cited 1× · see citing works
“With its more favorable pharmacokinetics allowing for once daily dosing and clinical trial evidence (9), levothyroxine monotherapy has prevailed as the treatment of choice for primary hypothyroidism.”
BackgroundShakir, M. K. M., Brooks, D. I., McAninch, E. A., Fonseca, T. L., Mai, V. Q., Bianco, A. C., & Hoang, T. D. (2021) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgab478 · Cited by 92 · see citing works
Trends in thyroid hormone prescribing and consumption in the UK
Mitchell, A. L., Hickey, B., Hickey, J. L., & Pearce, S. H. (2009) · BMC Public Health · doi:10.1186/1471-2458-9-132 · Cited by 73 · see citing works
Why does anyone still use desiccated thyroid USP?
JACKSON, I. M. D., & Cobb, W. E. (1978) · The American Journal of Medicine · doi:10.1016/0002-9343(78)90057-8 · Cited by 71 · see citing works
A Case of Myx dema Treated by Taking Extract of Thyroid by the Mouth
Fox, E. L. (1892) · BMJ · doi:10.1136/bmj.2.1661.941 · Cited by 52 · see citing works
Thyroid Hormone Use: Trends in the United States from 1960 Through 1988
Kaufman, S. C., Gross, T. P., & Kennedy, D. L. (1991) · Thyroid · doi:10.1089/thy.1991.1.285 · Cited by 45 · see citing works
Jha, S., Waghdhare, S., Reddi, R., & Bhattacharya, P. (2012) · Thyroid · doi:10.1089/thy.2011.0353 · Cited by 42 · see citing works
MANGIERI, C. N., & LUND, M. H. (1970) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-30-1-102 · Cited by 27 · see citing works
Anomalous Effects of Certain Preparations of Desiccated Thyroid on Serum Protein-Bound Iodine
Braverman, L. E., & Ingbar, S. H. (1964) · New England Journal of Medicine · doi:10.1056/nejm196402272700903 · Cited by 27 · see citing works
Trends in costs and prescribing for liothyronine and levothyroxine in England and wales 2011–2020
Stedman, M., Taylor, P., Premawardhana, L., Okosieme, O., Dayan, C., & Heald, A. H. (2021) · Clinical Endocrinology · doi:10.1111/cen.14414 · Cited by 16 · see citing works
Self-citationHeald, 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
Self-citationLiothyronine and levothyroxine prescribing in England: A comprehensive survey and evaluation
Stedman, M., Taylor, P., Premawardhana, L., Okosieme, O., Dayan, C., & Heald, A. H. (2021) · International Journal of Clinical Practice · doi:10.1111/ijcp.14228 · Cited by 8 · see citing works
Self-citationArmour® Thyroid Rage - A Dangerous Mixture
Coutinho, J., Field, J. B., & Sule, A. A. (2018) · Cureus · doi:10.7759/cureus.2523 · Cited by 4 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- McDowell, 1996, The general health questionnaire. Measuring health. A guide to rating scales and questionnaires
Cited by
Sorted by citations
Vargas‐Uricoechea, H., & Wartofsky, L. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25179218 · Cited by 11 · see citing works
An alternative source of medicines: pharmaceutical utilization of animal-derived metabolites
Renda, G. (2025) · Phytochemistry Reviews · doi:10.1007/s11101-025-10086-w · Cited by 5 · see citing works
How Does Thyroid Hormone Profile Differ on and Off Replacement Treatment?
Heald, A. H., Premawardhana, L. D. K. E., Taylor, P. N., Baker, A. R., Chaudhury, N., Fryer, A. A., Okosieme, O. E., Dayan, C. M., & Stedman, M. (2024) · Clinical Endocrinology · doi:10.1111/cen.15185 · Cited by 3 · see citing works
Self-citationStedman, M., Taylor, P. N., Halsall, I., Halsall, D. J., Okosieme, B., Bahl, S., Veluchamy, S., Premawardhana, L. D. K. E., Fryer, A. A., Dayan, C. M., et al. (2026) · Endocrinology Diabetes & Metabolism · doi:10.1002/edm2.70214
Self-citationTorre, S. C. D. L., Shakir, M. K. M., Davis, L. A., & Hoang, T. D. (2026) · AACE Endocrinology and Diabetes · doi:10.1016/j.aed.2026.07.020
- Authors
- Heald, A. H., Taylor, P., Premawardhana, L., Stedman, M., & Dayan, C.
- Affiliations
- Manchester Academic Health Science Centre (GB)
- Cardiff University (GB)
- Corresponding author
- Heald, Adrian H.
- Venue
- Frontiers in Endocrinology
- Publisher
- Frontiers Media SA
- Published
- 2024-01-08
- Volume
- 14
- Pages
- 1309159-1309159
- ISSN
- 1664-2392 (ISSN-L)
- PMC
- PMC10801060
- OpenAlex
- W4390666419
- Cited by
- 5
- References
- 26
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2
- FWCI
- 0.29
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Endocrinology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (publishedVersion, cc-by)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- 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, thyroid extract, thyroid hormone replacement
- MeSH terms
- Administration, Oral, Animals, Humans, Hypothyroidism, Swine, Thyroxine, Triiodothyronine
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