A Questionnaire Survey of German Thyroidologists on the Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients: The THESIS (Treatment of Hypothyroidism in Europe by Specialists: An International Survey) Collaborative

Abstract

Objective To identify the attitudes of German thyroid specialists towards the clinical treatment of hypothyroidism using thyroid hormones (TH). Methods All members of the thyroid section of the German Endocrine Society (DGE) were e-mailed an invitation to participate in a web-based survey about substitution with TH. Results Out of 206 members of the DGE’s thyroid section, 163 (79.1%) responses were received and included in the analysis. Of responding members, 98.6% used levothyroxine (LT4) as the treatment of choice, and 45.4% also prescribed combination therapy with liothyronine (LT4+LT3) in their clinical practice (p<0.001). LT4+LT3 combination was favored in patients with persistent hypothyroidism symptoms despite biochemical euthyroidism on LT4 treatment (p<0.001). Of all respondents, 26.4% never indicated TH therapy for euthyroid patients (p<0.001), while the remainder would consider THs for one or more indications (62.9% for euthyroid infertile women with high anti-thyroid antibody levels (p<0.001), 7.1% in patients with severe hypercholesterolemia, as complementary treatment (p=0.007), and 57.1% in patients with simple goiter (p<0.001)). In conditions that could interfere with LT4 absorption, most respondents still preferred tablets and did not expect a significant difference when switching from one LT4 formulation to another. Conclusion For German thyroid specialists, LT4 is the treatment of choice for hypothyroidism. Combination therapy with LT4+LT3 was considered for patients with persistent symptoms. Even in conditions that could affect bioavailability, German thyroid specialists prefer LT4 tablets rather than other LT4 formulations, such as liquid or soft-gel capsules. The widespread use of thyroid hormone for non-hypothyroid conditions is not consistent with current evidence and needs further study.

Use of thyroid hormones in hypothyroid and euthyroid patients: A THESIS questionnaire survey of UK endocrinologists

“…This survey of UK‐based clinical members of the Society for Endocrinology and the British Thyroid Association received valid responses from 21% of those eligible to respond. This crude response rate is a limitation of the study but is comparable to other reports 9 , 10 , 11 emerging from the pan‐European THESIS collaboration 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 and to similar North American 24 and European Thyroid Association surveys. 25 , 26 Furthermore, it might underestimate the proportion of thyroid specialists responding if, as seems likely, the clinical membership includes individuals with limited or no thyroid practice who chose not to participate.…”

“…Consistent with findings from other THESIS collaboration national surveys 9,11,14,15,17,20,21,23 the proportion of UK endocrinologists who would themselves consider taking combined LT4 + LT3 treatment, in the event of developing hypothyroidism, is smaller still than the proportion currently prescribing. While it is apparent that, for many, concerns about safety, dosing inconvenience, and lack of evidence of efficacy inform this opinion, the questionnaire was not designed to determine whether a perception of low personal risk of suffering persistent symptoms might also be relevant.…”

“…This is illustrated by the differing approach to the THESIS survey taken in Germany, surveying only members of the thyroid subsection (n = 206) of the Deutsche Gesellschaft für Endokrinologie (total membership approximately 1660) and obtaining a 79.1% response rate with 163 responses. 23 A further limitation of the study is that the views of general practitioners, who successfully manage most hypothyroidism in the Stringent measures ensured that responses were received only from eligible members and excluded duplicates. Almost all respondents reported managing thyroid patients weekly or daily.…”

“…This is illustrated by the differing approach to the THESIS survey taken in Germany, surveying only members of the thyroid subsection ( n = 206) of the Deutsche Gesellschaft für Endokrinologie (total membership approximately 1660) and obtaining a 79.1% response rate with 163 responses. 23 …”

Enhanced Well-Being Associated with Thyrotoxicosis: A Neglected Effect of Thyroid Hormones?

“…Thyroid hormone containing "pep pills" were popular in the past (33) and "thyroid hormone abuse" (consumption of thyroid hormones for weight loss, or to improve energy) continues today occasionally with catastrophic consequences (34). Indeed recent evidence from several European countries suggests that thyroid hormones are still used by a minority of physicians (2.2 -8%) in euthyroid patients for weight loss (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50).…”