Scientific publications
Patients' Persistent Symptoms, Clinician Demographics, and Geo-Economic Factors Are Associated with Choice of Therapy for Hypothyroidism by European Thyroid Specialists: The "THESIS" Collaboration
Roberto Attanasio 1 , Miloš Žarković 2 , Enrico Papini 3 , Endre Vezekenyi Nagy 4 , Roberto Negro 5 , Petros Perros 6 , Ersin Akarsu 7 , Maria Alevizaki 8 , Göksun Ayvaz 9 , Tomasz Bednarczuk 10 , Biljana Nedeljković Beleslin 2 , Eszter Berta 4 , Miklos Bodor 4 , Anna Maria Borissova 11 , Mihail Boyanov 12 13 , Camille Buffet 14 , Maria-Cristina Burlacu 15 , Jasmina Ćirić 2 , Juan J Díez 16 17 18 , Harald Dobnig 19 20 , Valentin Fadeyev 21 , Benjamin C T Field 22 , Eric Fliers 23 , Dagmar Führer-Sakel 24 , Juan Carlos Galofré 25 26 , Tommi Hakala 27 , Jan Jiskra 28 , Peter A Kopp 29 , Michael Krebs 30 , Michal Kršek 28 , Martin Kužma 31 , Mikael Lantz 32 , Ivica Lazúrová 33 , Laurence Leenhardt 14 , Vitaliy Luchytskiy 34 , Francisca Marques Puga 35 , Anne McGowan 36 , Saara Metso 37 , Carla Moran 38 39 , Tatyana Morgunova 21 , Dan Alexandru Niculescu 40 , Božidar Perić 41 , Tereza Planck 32 , Catalina Poiana 40 , Eyal Robenshtok 42 , Patrick Olivier Rosselet 43 , Marek Ruchala 44 , Kamilla Ryom Riis 45 , Alla Shepelkevich 46 , Mykola D Tronko 47 , David Unuane 48 , Irfan Vardarli 49 50 , W Edward Visser 51 , Andromachi Vryonidou 52 , Younes Ramazan Younes 53 , Laszlo Hegedüs 45
Background
Hypothyroidism is common, however, aspects of its treatment remain controversial. Our survey aimed at documenting treatment choices of European thyroid specialists and exploring how patients' persistent symptoms, clinician demographics, and geo-economic factors relate to treatment choices.
Methods
Seventeen thousand two hundred forty-seven thyroid specialists from 28 countries were invited to participate in an online questionnaire survey. The survey included respondent demographic data and treatment choices for hypothyroid patients with persistent symptoms. Geo-economic data for each country were included in the analyses.
Results
The response rate was 32.9% (6058 respondents out of 17,247 invitees). Levothyroxine (LT4) was the initial treatment preferred by the majority (98.3%). Persistent symptoms despite normal serum thyrotropin (TSH) while receiving LT4 treatment were reported to affect up to 10.0% of patients by 75.4% of respondents, while 28.4% reported an increasing such trend in the past 5 years. The principal explanations offered for patients' persistent symptoms were psychosocial factors (77.1%), comorbidities (69.2%), and unrealistic patient expectations (61.0%). Combination treatment with LT4+liothyronine (LT3) was chosen by 40.0% of respondents for patients who complained of persistent symptoms despite a normal TSH. This option was selected more frequently by female thyroid specialists, with high-volume practice, working in countries with high gross national income per capita.
Conclusions
The perception of patients' dissatisfaction reported by physicians seems lower than that described by hypothyroid patients in previous surveys. LT4+LT3 treatment is used frequently by thyroid specialists in Europe for persistent hypothyroid-like symptoms even if they generally attribute such symptoms to nonendocrine causes and despite the evidence of nonsuperiority of the combined over the LT4 therapy. Pressure by dissatisfied patients on their physicians for LT3-containing treatments is a likely explanation. The association of the therapeutic choices with the clinician demographic characteristics and geo-economic factors in Europe is a novel information and requires further investigation.
CITATION Thyroid. 2024 Apr;34(4):429-441. doi: 10.1089/thy.2023.0580. Epub 2024 Mar 22
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