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

Irfan Vardarli; Tim Brandenburg; Laszlo Hegedüs; Roberto Attanasio; EndreV. Nagy; Enrico Papini; Petros Perros; Frank Weidemann; Ken Herrmann; Dagmar Führer

doi:10.1055/a-1832-0644

Experimental and Clinical Endocrinology & Diabetes, Inhaltsverzeichnis

Exp Clin Endocrinol Diabetes 2022; 130(09): 577-586
DOI: 10.1055/a-1832-0644

Article

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

Irfan Vardarli

¹Department of Medicine I, Klinikum Vest, Knappschaftskrankenhaus Recklinghausen, Academic Teaching Hospital, Ruhr-University Bochum, Recklinghausen, Germany

,

Tim Brandenburg

²Department of Endocrinology, Diabetes, and Metabolism, Clinical Chemistry – Division of Laboratory Research; Endocrine Tumor Center at WTZ/Comprehensive Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany

,

Laszlo Hegedüs

³Department of Endocrinology, Odense University Hospital, Denmark

,

Roberto Attanasio

⁴Scientific Committee Associazione Medici Endocrinologi, Milan, Italy

,

EndreV. Nagy

⁵Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

,

Enrico Papini

⁶Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Rome, Italy

,

Petros Perros

⁷Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom

,

Frank Weidemann

¹Department of Medicine I, Klinikum Vest, Knappschaftskrankenhaus Recklinghausen, Academic Teaching Hospital, Ruhr-University Bochum, Recklinghausen, Germany

,

Ken Herrmann

⁸Department of Nuclear Medicine, University Hospital Essen, Essen, Germany

,

Dagmar Führer

²Department of Endocrinology, Diabetes, and Metabolism, Clinical Chemistry – Division of Laboratory Research; Endocrine Tumor Center at WTZ/Comprehensive Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany

› Institutsangaben

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.

Key words

Thyroid hormones - levothyroxine - liothyronine - combination therapy - bioavailability - hypothyroidism - questionnaire

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