Use of thyroid hormones in hypothyroid and euthyroid patients: a THESIS* questionnaire survey of Polish physicians. *THESIS: Treatment of hypothyroidism in Europe by specialists: an international survey
Open accessAbstract
INTRODUCTION: Over the past several years new evidence on the management of hypothyroidism has emerged, which has influenced recommendations from professional bodies. The presentation of hypothyroid patients has also changed, and new cases are increasingly diagnosed by indiscriminate screening, often identifying cases with minor biochemical disturbances. Little is known about the physician responses and attitudes to this changing landscape. THESIS (Treatment of Hypothyroidism in Europe by Specialists: an International Survey) is a large-scale survey of European physicians who treat patients with hypothyroidism. Here we document current practices of Polish physicians relating to the use of thyroid hormones in hypothyroid and euthyroid patients. MATERIAL AND METHODS: Members of the Polish Society of Endocrinology were invited to participate in the web-based THESIS survey. RESULTS: In total 423 (54.6% of the 774 invited) physicians completed the survey. The majority of respondents (74.2%) would prescribe thyroid hormones foreuthyroid patients for certain indications, such as female infertility with elevated thyroid antibodies (63.4%), simple goitre (40.9%), unexplained fatigue (12.1%), obesity (9.7%), hypercholesterolaemia (9.0%), and depression (9.2%). Nearly all physicians (96.0%) declared that the treatment of choice for hypothyroidism is levothyroxine (LT4). However, around one-third (30.3%) were also using LT4 and liothyronine (LT3) combination treatment; LT3 alone was rarely prescribed (1.7%), and none prescribed desiccated thyroid extract. The majority of respondents preferred LT4 tablets. Among alternative formulations, liquid LT4 was most commonly recommended for patients unable to take LT4 in the fasting state (26.0%) and patients with malabsorption (19.9%). Respondents considered prescribing dietary supplements (such as selenium and iodine) in hypothyroid patients with coexisting autoimmune thyroiditis (29.6%) or at the patients' request (32.2%). LT4 + LT3 combination therapy was used by 32.2% when symptoms persisted notwithstanding normal serum TSH concentration. Psychosocial factors, comorbidities, and the burden of chronic disease were considered as the most likely causes of persistent symptoms. CONCLUSIONS: Apart from clinical practice recommendations, other factors influence the thyroid hormone therapy patterns. Moreover, certain areas of clinical practice were identified (the use of thyroid hormones in euthyroid subjects and the use of dietary supplements), which are not in accordance with the current evidence.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
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 [36]
In “Perceptions about persistence of hypothyroid symptoms despite normal serum TSH” (page unavailable), 36.4% of respondents said they were seeing more such cases. That supports the reported perception of an increase, but not the claim that most respondents held it. (LLM, conf=0.90)
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 [36]
In “Perceptions about persistence of hypothyroid symptoms despite normal serum TSH” (page unavailable), the paper reports that 36.4% of respondents said they were seeing more such cases, supporting “approximately one-third.” Our copy does not specify that this increase occurred over the last five years. (LLM, conf=0.84)
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 [36]
In 'Perceptions about persistence of hypothyroid symptoms despite normal serum TSH' (page unavailable), the paper reports that 65.7% of respondents considered psychosocial factors a likely cause. Table 5 ranks chronic fatigue syndrome among the perceived causes, but the cited passages do not support the claimed figure of up to 85%. (LLM, conf=0.88)
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 [36]
In “Perceptions about persistence of hypothyroid symptoms despite normal serum TSH” (page unavailable), 52.7% of respondents disagreed that LT4 treatment was unable to restore normal physiology, and the paper describes that as the least likely explanation for persistent symptoms. It links this discussion to low serum T3, but does not report respondents’ views on a specifically named “low tissue T3 hypothesis” or ask whether it plays a major causal role. (LLM, conf=0.82)
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 [36]
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 [36]
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 [36]
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 [36]
The section on persistent hypothyroid symptoms reports Polish physicians’ estimates of symptom prevalence, but does not compare countries by GDP. Searches for GDP and gross domestic product found no passage addressing the claimed high- versus low-GDP pattern. (LLM, conf=0.76)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
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 · see citing works
Garber, 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
Global 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
Gharib, H., Papini, E., Garber, J. R., Duick, D. S., Harrell, R. M., Hegedűs, L. D., Paschke, R., Valcavi, R., & Vitti, P. (2016) · Endocrine Practice · doi:10.4158/ep161208.gl · Cited by 1,285 · see citing works
Self-citationHypothyroidism in Context: Where We’ve Been and Where We’re Going
Chiovato, L., Magri, F., & Carlé, A. (2019) · Advances in Therapy · doi:10.1007/s12325-019-01080-8 · Cited by 491 · see citing works
2012 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 · cited 1× · see citing works
“The available tablets in Poland containing LT4 + LT3 have an “unphysiological” high ratio of T4 to T3 (5:1), whereas it is assumed that thyroid hormone replacement should be provided as a 14:1 ratio of T4 to T3 [5,39].”
BackgroundBonnema, S. J., & Hegedűs, L. D. (2012) · Endocrine Reviews · doi:10.1210/er.2012-1030 · Cited by 338 · see citing works
Self-citationLevothyroxine in Women with Thyroid Peroxidase Antibodies before Conception
Dhillon-Smith, R. K., Middleton, L. J., Sunner, K. K., Cheed, V., Baker, K., Farrell-Carver, S., Bender-Atik, R., Agrawal, R., Bhatia, K., Edi-Osagie, E., et al. (2019) · New England Journal of Medicine · doi:10.1056/nejmoa1812537 · Cited by 303 · see citing works
Taylor, P. N., Iqbal, A., Minassian, C., Sayers, A., Draman, M. S., Greenwood, R., Hamilton, W., Okosieme, O., Panicker, V., Thomas, S. L., et al. (2014) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.11312 · Cited by 300 · see citing works
Selenium in thyroid disorders—essential knowledge for clinicians
Winther, K. H., Rayman, M. P., Bonnema, S. J., & Hegedüs, L. (2020) · Nature Reviews Endocrinology · doi:10.1038/s41574-019-0311-6 · Cited by 288 · see citing works
Self-citationTreatment with thyroid hormone
Biondi, B., & Wartofsky, L. (2014) · Endocrine Reviews · doi:10.1210/er.2013-1083 · Cited by 259 · see citing works
Wang, H., Gao, H., Chi, H., Zeng, L., Xiao, W., Wang, Y., Li, R., Liu, P., Wang, C., Tian, Q., et al. (2017) · JAMA · doi:10.1001/jama.2017.18249 · Cited by 238 · see citing works
An Online Survey of Hypothyroid Patients Demonstrates Prominent Dissatisfaction
Peterson, S. J., Cappola, A. R., Castro, M. R., Dayan, C. M., Farwell, A. P., Hennessey, J. V., Kopp, P. A., Ross, D. S., Samuels, M. H., Sawka, A. M., et al. (2018) · Thyroid · doi:10.1089/thy.2017.0681 · Cited by 231 · see citing works
Wichman, J. E. M., Winther, K. H., Bonnema, S. J., & Hegedűs, L. D. (2016) · Thyroid · doi:10.1089/thy.2016.0256 · Cited by 223 · see citing works
Self-citationGastrointestinal malabsorption of thyroxine
Virili, C., Antonelli, A., Santaguida, M. G., Benvenga, S., & Centanni, M. (2019) · Endocrine Reviews · doi:10.1210/er.2018-00168 · Cited by 164 · see citing works
Lillevang‐Johansen, M., Abrahamsen, B., Jørgensen, H. L., Brix, T. H., & Hegedűs, L. D. (2019) · Thyroid · doi:10.1089/thy.2018.0320 · Cited by 101 · see citing works
Self-citationAbrahamsen, B., Jørgensen, H. L., Laulund, A. S., Nybo, M., Bauer, D. C., Brix, T. H., & Hegedüs, L. (2015) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.2416 · Cited by 98 · see citing works
Self-citationMitchell, A. L., Hegedüs, L., Žarković, M., Hickey, J. L., & Perros, P. (2021) · Clinical Endocrinology · doi:10.1111/cen.14340 · Cited by 81 · see citing works
Self-citationJonklaas, 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) · European Thyroid Journal · doi:10.1159/000512970 · Cited by 78 · see citing works
A 2013 Survey of Clinical Practice Patterns in the Management of Primary Hypothyroidism
Burch, H. B., Burman, K. D., Cooper, D. S., & Hennessey, J. V. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-1046 · Cited by 73 · see citing works
New Formulations of Levothyroxine in the Treatment of Hypothyroidism: Trick or Treat?
Nagy, E. V., Perros, P., Papini, E., Katkó, M., & Hegedűs, L. D. (2020) · Thyroid · doi:10.1089/thy.2020.0515 · Cited by 65 · see citing works
Self-citationAmbroziak, U., Hybsier, S., Shahnazaryan, U., Krasnodębska‐Kiljańska, M., Rijntjes, E., Bartoszewicz, Z., Bednarczuk, T., & Schomburg, L. (2017) · Journal of Trace Elements in Medicine and Biology · doi:10.1016/j.jtemb.2017.08.005 · Cited by 59 · see citing works
Self-citationThe economic impact of levothyroxine dose adjustments: the CONTROL HE study
Ernst, F. R., Barr, P., Elmor, R., Sandulli, W., Thevathasan, L., Sterman, A. B., Goldenberg, J., & Vora, K. (2017) · Clinical Drug Investigation · doi:10.1007/s40261-016-0462-3 · Cited by 53 · see citing works
Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients; the 2019 Italian Survey
Negro, R., Attanasio, R., Nagy, E. V., Papini, E., Perros, P., & Hegedüs, L. (2020) · European Thyroid Journal · doi:10.1159/000502057 · Cited by 52 · see citing works
Self-citationThe majority of Danish nontoxic goitre patients are ineligible for Levothyroxine suppressive therapy
Fast, S., Bonnema, S. J., & Hegedűs, L. D. (2008) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2008.03241.x · Cited by 47 · see citing works
Self-citationTrends, Determinants, and Associations of Treated Hypothyroidism in the United Kingdom, 2005–2014
Razvi, S., Korevaar, T. I. M., & Taylor, P. (2019) · Thyroid · doi:10.1089/thy.2018.0251 · Cited by 45 · see citing works
Physician Choice of Hypothyroidism Therapy: Influence of Patient Characteristics
Jonklaas, J., Tefera, E., & Shara, N. (2018) · Thyroid · doi:10.1089/thy.2018.0325 · Cited by 41 · see citing works
Guglielmi, R., Frasoldati, A., Zini, M., Grimaldi, F., Gharib, H., Garber, J. R., & Papini, E. (2016) · Endocrine Practice · doi:10.4158/ep161308.or · Cited by 39 · see citing works
Self-citationRuchała, M., Szczepanek‐Parulska, E., & Zybek, A. (2012) · PubMed · Cited by 38 · see citing works
Self-citationRiis, K. R., Frølich, J. S., Hegedüs, L., Negro, R., Attanasio, R., Nagy, E. V., Papini, E., Perros, P., & Bonnema, S. J. (2021) · Journal of Endocrinological Investigation · doi:10.1007/s40618-021-01555-y · Cited by 37 · see citing works
Self-citationTrofimiuk-Müldner, M., Konopka, J., Sokołowski, G., et al. (2020) · Public Health Nutrition · doi:10.1017/s1368980020000403 · Cited by 36 · see citing works
T4 + T3 combination therapy: any progress?
Wiersinga, W. M. (2019) · Endocrine · doi:10.1007/s12020-019-02052-2 · Cited by 35 · see citing works
Winther, K. H., Papini, E., Attanasio, R., Negro, R., & Hegedűs, L. D. (2020) · European Thyroid Journal · doi:10.1159/000504781 · Cited by 33 · see citing works
Self-citation[Management of thyroid diseases during pregnancy].
Hubalewska–Dydejczyk, A., Lewiñski, A., Milewicz, A., et al. (2011) · PubMed · 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 · cited 1× · see citing works
“However, the availability of alternative forms of thyroid hormone replacement therapy varies between countries [13].”
BackgroundGietka-Czernel, M., Hubalewska-Dydejczyk, A., Kos-Kudła, B., Lewiński, A., Ruchała, M., Syrenicz, A., & Zgliczyński, W. (2020) · Endokrynologia Polska · doi:10.5603/ep.a2020.0065 · Cited by 13 · see citing works
Self-citationElmor, R., Sandulli, W., & Carter, C. A. (2017) · Pharmacoeconomics open access · doi:10.4172/2472-1042.1000113 · Cited by 10 · see citing works
The economic impact of switching from synthroid for the treatment of hypothyroidism
Khandelwal, N., Johns, B., Hepp, Z., & Castelli-Haley, J. (2018) · Journal of Medical Economics · doi:10.1080/13696998.2018.1443110 · Cited by 10 · see citing works
Cross-national comparison of levothyroxine utilization in four developed countries
Frank, R., Mamdani, M., & Wilby, K. J. (2014) · Journal of Health Specialties · doi:10.4103/1658-600x.142785 · Cited by 7 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients: a THESIS* Questionnaire Survey of Bulgarian Physicians | Българско дружество по ендокринология. https://endo-bg.com/en/prilozhe- nie-na-hormonite-na-shtitovidnata-zhleza-pri-hipotireoidni-i-eutireoid- ni-patsienti-anketno-prouchvane-thesis-sred-balgarski-lekari/ (March 31, 2021).
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
Riis, K. R., Frølich, J. S., Hegedüs, L., Negro, R., Attanasio, R., Nagy, E. V., Papini, E., Perros, P., & Bonnema, S. J. (2021) · Journal of Endocrinological Investigation · doi:10.1007/s40618-021-01555-y · Cited by 37 · see citing works
Self-citationYi, W., Kim, B. H., Kim, M., Kim, J., Im, M., Ryang, S., Kim, E. H., Jeon, Y. K., Kim, S. S., & Kim, I. J. (2022) · Thyroid · doi:10.1089/thy.2021.0634 · Cited by 36 · see citing works
Perros, P., Nagy, E. V., Papini, E., Van Der Feltz-Cornelis, C. M., Weetman, A. P., Hay, H. A., Abad-Madroñero, J., Tallett, A. J., Bilas, M., Lakwijk, P., et al. (2023) · Thyroid · doi:10.1089/thy.2022.0641 · Cited by 27 · see citing works
T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity
Wiersinga, W. M. (2021) · Endocrinology and Metabolism · doi:10.3803/enm.2021.501 · Cited by 21 · see citing works
Younes, Y. R., Perros, P., Hegedüs, L., Papini, E., Nagy, E. V., Attanasio, R., Negro, R., & Field, B. C. T. (2023) · Clinical Endocrinology · doi:10.1111/cen.14812 · Cited by 19 · see citing works
Self-citationAttanasio, R., Žarković, M., Papini, E., Nagy, E. V., Negro, R., Perros, P., Akarsu, E., Alevizaki, M., Ayvaz, G., Bednarczuk, T., et al. (2024) · Thyroid® · doi:10.1089/thy.2023.0580 · Cited by 11 · see citing works
Self-citation
- Authors
- Bednarczuk, T., Attanasio, R., Hegedüs, L., Nagy, E. V., Negro, R., Papini, E., Perros, P., & Ruchała, M.
- Affiliations
- Medical University of Warsaw (PL)
- IRCCS Ospedale Galeazzi - Sant'Ambrogio (IT)
- University of Debrecen (HU)
- Ospedale Vito Fazzi (IT)
- Ospedale Regina Apostolorum (IT)
- Royal Victoria Infirmary (GB)
- Poznan University of Medical Sciences (PL)
- ORCID
- Venue
- Endokrynologia Polska
- Publisher
- VM Media SP. zo.o VM Group SK
- Published
- 2021-08-11
- Volume
- 72
- Issue
- 4
- Pages
- 357-365
- ISSN
- 0423-104X (ISSN-L)
- 2299-8306
- OpenAlex
- W3160864592
- Cited by
- 33
- References
- 39
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 5 · 2023: 3 · 2022: 12 · 2021: 7
- FWCI
- 5.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- other-oa
- Locations
- Endokrynologia Polska (publishedVersion, other-oa)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity) (cc-by-nc-nd)
- 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, thyroid hormone replacement, levothyroxine, liothyronine, desiccated thyroid extract, physician prescribing, euthyroid patients, autoimmune thyroiditis, Polish physicians
- MeSH terms
- Female, Humans, Hypothyroidism, Physicians, Poland, Surveys and Questionnaires, Thyroid Hormones, Thyroxine
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
