Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients: A Thesis* Questionnaire Survey of Romanian Physicians *Thesis: Treatment of Hypothyroidism in Europe by Specialists: An International Survey
Open accessAbstract
OBJECTIVE: Romania has no national guidelines for hypothyroidism treatment, nor are there any recommendations from national societies to adhere to international guidelines. Our aim was to identify the attitudes of Romanian physicians relating to hypothyroidism treatment focusing on available formulations of levothyroxine (LT4). METHODS: All 748 members of the Romanian Society of Endocrinology were invited to participate in a web-based survey. A total of 316 (42.24%) members responded, of whom 222 (70.2%) completed all questions. RESULTS: . 9.8%). The most and least probable explanations for persistent symptoms in patients with hypothyroidism who achieve a normal TSH under medication were "psychosocial factors" and "burden of having to take medication", respectively. CONCLUSION: A significant proportion of Romanian physicians would use LT4 in some groups of euthyroid patients, contrary to current evidence. The preferred treatment for hypothyroidism was LT4. Alternative LT4 formulations (liquid solution) are considered in specific clinical conditions. Diversification of available thyroid hormone formulations was readily incorporated into everyday practice.
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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 [35]
The Results section reports that respondents generally considered the proportion of patients with persistent symptoms to be unchanged (31.8%) or decreasing (24.1%), not increasing. Together, those responses account for a majority. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredChronic fatigue syndrome and the burden of having to take medication are also viewed-but less strongly-as likely explanations, whereas respondents are divided about the role of inflammation due to autoimmunity.
“Chronic fatigue syndrome and the burden of having to take medication are also viewed—but less strongly—as likely explanations, whereas respondents are divided about the role of inflammation due to autoimmunity.”
From T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity (2021) · cites this paper as [35]
The Results (page unavailable) list chronic fatigue syndrome and the burden of taking medication as possible explanations for persistent symptoms, ranked below psychosocial factors and comorbidities. But the text does not show whether respondents generally considered both explanations likely or were divided about inflammation due to autoimmunity; it points to Figure 2 for those responses. (LLM, conf=0.82)
Experimental — accuracy not yet measuredApproximately 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 [35]
The Results section reports respondents’ views on whether persistent symptoms were changing, so the paper addresses the survey topic. It gives 31.8% as saying the proportion was not changing and 24.1% as saying it was decreasing; the passage does not establish that approximately one-third said it had increased over the last five years. No page number is available in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredUp to 85% of THESIS survey respondents thought that psychosocial factors and chronic fatigue syndrome can play a causal role in persistent symptoms.
“Up to 85% of respondents in the THESIS survey thought that psychosocial factors and chronic fatigue syndrome can play a causal role in persistent symptoms.”
From T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity (2021) · cites this paper as [35]
The Results section lists psychosocial factors and chronic fatigue syndrome among respondents’ possible explanations for persistent symptoms, supporting the substance of the claim. It refers to Figure 2 for the response breakdown, but the passages in our copy do not give an 85% figure or establish that 85% endorsed both factors. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe majority of THESIS survey respondents disagreed that the low tissue T3 hypothesis plays a major causal role in persistent complaints.
“The most remarkable finding in the questionnaire survey is that the majority of respondents disagreed that the “low tissue T3 hypothesis” plays a major causal role in persistent complaints.”
From T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity (2021) · cites this paper as [35]
The Results list “inability of LT4 to restore normal physiology” among possible explanations for persistent symptoms, and the Discussion says it gained little support from respondents. Our copy does not call this the “low tissue T3 hypothesis” or establish that a majority specifically disagreed with it. (LLM, conf=0.83)
Experimental — accuracy not yet measured
The inability of LT4 to restore physiological function is viewed as an unlikely cause of persistent symptoms by endocrinologists in the THESIS survey.
“Applying this assumption, it is clear that the inability of LT4 to restore physiological function is viewed as an unlikely cause of persistent symptoms, whereas psychosocial factors, comorbidities, unrealistic expectations, and the burden of chronic disease are considered to be more likely causes.”
From T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity (2021) · cites this paper as [35]
Psychosocial factors, comorbidities, unrealistic expectations, and the burden of chronic disease are considered to be more likely causes of persistent symptoms by THESIS survey respondents.
“Applying this assumption, it is clear that the inability of LT4 to restore physiological function is viewed as an unlikely cause of persistent symptoms, whereas psychosocial factors, comorbidities, unrealistic expectations, and the burden of chronic disease are considered to be more likely causes.”
From T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity (2021) · cites this paper as [35]
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 [35]
The Results section reports Romanian physicians’ estimates of persistent symptoms among treated patients, but it does not compare countries by GDP. Searches for GDP and cross-country differences found no passage in our copy addressing the claimed high-versus-low-GDP pattern; page numbers were not available. (LLM, conf=0.76)
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- Authors
- Niculescu, D.
- Affiliations
- Carol Davila University of Medicine and Pharmacy (RO)
- Corresponding author
- Niculescu, D
- ORCID
- Niculescu, D
- Venue
- Acta Endocrinologica (Bucharest)
- Publisher
- ACTA Endocrinologica Foundation
- Published
- 2020
- Volume
- 16
- Issue
- 4
- Pages
- 462-469
- ISSN
- 1841-0987 (ISSN-L)
- 1843-066X
- PMC
- PMC8126379
- OpenAlex
- W3162908408
- Cited by
- 28
- References
- 25
- Citations by year
- 2025: 3 · 2024: 4 · 2023: 3 · 2022: 14 · 2021: 4
- FWCI
- 3.96
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Acta Endocrinologica (Bucharest) (publishedVersion)
- PubMed Central (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion, other-oa)
- 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 › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- hypothyroidism, levothyroxine, euthyroid patients, physician attitudes, treatment guidelines, thyroid-stimulating hormone, Romania
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