Use of thyroid hormones in hypothyroid and euthyroid patients: a 2022 THESIS questionnaire survey of members of the Latin American Thyroid Society (LATS)

Jessica F Cassemiro; Veronica Ilera; Stella Batalles; Adriana Reyes; Endre V Nagy; Enrico Papini; Petros Perros; Laszlo Hegedüs; Helton Estrela Ramos

doi:10.1186/s13044-023-00182-4

Use of thyroid hormones in hypothyroid and euthyroid patients: a 2022 THESIS questionnaire survey of members of the Latin American Thyroid Society (LATS)

Thyroid Res. 2023 Sep 29;16(1):40. doi: 10.1186/s13044-023-00182-4.

Authors

Jessica F Cassemiro¹, Veronica Ilera², Stella Batalles³, Adriana Reyes², Endre V Nagy⁴, Enrico Papini⁵, Petros Perros⁶, Laszlo Hegedüs⁷, Helton Estrela Ramos⁸

Affiliations

¹ Department of Bioregulation, Health & Science Institute, Federal University of Bahia, Avenida Reitor Miguel Calmon, S/N. Vale do Canela. Room 325, Salvador, Bahia, Brazil.
² Department of Endocrinology, Hospital Ramos Mejía, Caba, Argentina.
³ Cardiovascular Institute of Rosario, Santa Fe, Argentina.
⁴ Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
⁵ Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy.
⁶ Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
⁷ Department of Endocrinology, Odense University Hospital, Odense, Denmark.
⁸ Department of Bioregulation, Health & Science Institute, Federal University of Bahia, Avenida Reitor Miguel Calmon, S/N. Vale do Canela. Room 325, Salvador, Bahia, Brazil. ramoshelton@gmail.com.

Abstract

Purpose: Inconsistencies in the medical management of hypothyroidism have been reported between endocrinologists in different countries. This study aimed to identify the attitudes of Latin America thyroid specialists towards the use of thyroid hormones.

Methods: Online survey of members of the Latin America Thyroid Society.

Results: 81/446 (18.2%) completed the questionnaire. Levothyroxine (LT4) was the initial treatment of choice for all respondents. 56.8% would consider LT4 use in biochemically euthyroid patients: infertile women with elevated anti-thyroid antibodies (46.9%), resistant depression (17.3%) and growing goiter (12%). Most respondents preferred tablets (39.5%) over liquid formulations (21.0%) or soft gel capsules (22.2%) and would not consider switching formulations in patients with persistent symptoms. 39.5% would never use LT4 + liothyronine (LT3) combination therapy in symptomatic euthyroid patients, due to low quality evidence for benefit. 60.5% reported that persistence of symptoms despite normal TSH is rare (below 5% of patients) and its prevalence has been stable over the last five years. Psychosocial factors (84.0%), comorbidities (86.4%) and the patient unrealistic expectation (72.8%) were considered the top three explanations for this phenomenon.

Conclusion: LT4 tablets is the treatment of choice for hypothyroidism. A significant proportion of respondents would use LT4 in some groups of euthyroid individuals, contrasting the recommendations of the major clinical practice guideline indications. LT4 + LT3 combination treatment in euthyroid symptomatic patients was considered by nearly 50%. Practices based on weak or absent evidence included use of thyroid hormones for euthyroid subjects by 56.8% of respondents and use of LT4 + LT3 treatment by 60.5% of respondents for patients with persistent symptoms. In contrast to many European countries, LATS respondents report a low and unchanged proportion of dissatisfied patients over the last five years.

Keywords: Euthyroidism; Hypothyroidism; Latin American Thyroid Society; Levothyroxine; Liothyronine; Survey.