In the US they more often prescribe T3 and NDT for hypothyroidism than is the case elsewhere

[diogenes]

I thought you might be interested in this latest article in Thyroid. Its no comfort to patients in the UK, but I also thought it might be comforting to know that mot everywhere is T3/NDT prescribing frowned on.

Thyroid VOL. 29, NO. 1 | Thyroid Dysfunction: Hypothyroidism, Thyrotoxicosis, and Thyroid Function Tests normal

Prescribing Therapy for Hypothyroidism: Influence of Physician Characteristics

Jacqueline Jonklaas, Eshetu Tefera, and Nawar Shara

Published Online: 23 Jan 2019 doi.org/10.1089/thy.2018.0369

Abstract

Background: Physician characteristics and perceptions and their effect on choice of therapies for patients with thyroid cancer have been well studied. Some data also exist about physician characteristics and prescribing treatment for subclinical hypothyroidism. The effect of physician characteristics on prescribing thyroid preparations for treating overt hypothyroidism is less studied.

Methods: Members of the American Thyroid Association were surveyed in 2017. Physicians were presented with 13 different theoretical patients with hypothyroidism and asked to choose among six therapeutic options, including levothyroxine, synthetic combination therapy, thyroid extract, and liothyronine monotherapy. The 13 patient scenarios incorporated parameters that potentially provide reasons for considering combination therapy (presence of symptoms, low serum triiodothyronine concentration, and documentation of deiodinase polymorphisms). Repeated-measures logistic regression analysis was performed to examine the prescribing of the various therapies. Data regarding the responding physicians were also collected. These data included number of years in practice, country of practice, and specialty. Multivariate repeated-measures logistic regression analysis of prescribing patterns was also conducted controlling for all patient and physician characteristics.

Results: Of the 389 survey respondents, 93% prescribed therapy for hypothyroidism. Fifty-three percent of respondents had been in practice for >20 years, and 23% had been in practice for 11–20 years. Sixty-four percent practiced in North America, and 18% practiced in Europe. Eight-six percent were endocrinologists, and 5% were surgeons. In multivariate analysis, physicians from North America were both more likely to prescribe any triiodothyronine-containing therapies (odds ratio [OR] = 1.8 [confidence interval (CI) 1.3–2.4]) and more likely to add liothyronine to levothyroxine therapy (OR = 1.9 [CI 1.2–2.9]). In addition, they were more likely to prescribe desiccated thyroid extract or liothyronine monotherapy (OR = 1.7 [CI 1.0–2.9]).

Conclusions: A previous analysis of this survey showed that patient characteristics profoundly affect physician prescribing patterns. The current multivariate analysis shows that physician characteristics affect prescribing patterns. Whether this is due to impact upon physicians of patient-related experiences, media exposure, influence from pharmaceutical companies, educational activities, or other concerns cannot be determined. However, these results have potential importance for understanding physician–patient interactions at a time when the benefits and risks of triiodothyronine-containing therapies have not been fully documented.

[Hidden]

Wish we could emigrate! Problem is you have to pay for all medical care in the US, unless you have health insurance!

[jgelliss in reply to Hidden]

In a more perfect world by design . It would be nice rather essential that thyroid patients ought to be able to have self testing kits as do diabetic patients to test thyroid FT3 FT4 TSH .

T3 T4 NDT should be made available to patients as needed by patients . Cellular symptoms are more telling and *Only* the patient knows Best how they feel . Not Dr's/Endo's . While B/W is *only* a snapshot of the moment the B/W was drawn .

Thyroid meds T3 T4 NDT ought to be *plentiful* and *without reformulations* good meds that work well *Consistency* is vital . Don't try to short change thyroid patients . Make it Available at a decent cost without breaking the bank . Universally .

We are not asking for much . Only what's due us .

This may just be very cost affective with our Health Care and Health Insurance too . The way I see it It's a win win for all .

[LAHs]

Thats really interesting, I wish they had also recorded the physicians' age and gender, I have found those to be the two main factors. I am in the US and have found that women docs will not prescribe T3 or NDT but young male docs will. Of course my experience is just one anecdotal occurrence so doesn't count for anything. However, if I ever have to look for another doctor who will prescribe me NDT I will look for a young male Asian (as my present one is). As for old women, forget it, they are terrified of going against the "rules" (from the AMA).

Gosh that sounds terribly racist and sexist but when it comes to my life or well being I will not be politically correct. I apologize if I have hurt any one's feelings especially old women - I am one myself, so I know what I am talking about.

[Naomi8]

Yesterday I had my first appointment with my new GP(relocation from Cumbria to Sussex)

He called me in to review my thyroid function test results taken on joining.

FT4...13(12-22)

FT3...4.9(3.10-6.8)

TSH .03

I told him I am taking 2 grains NDT & he immediately booked me an appointment to see the endo,as he has no knowledge of NDT & therefore the blood test results were not something he even attempted to interpret.

The endo I saw in Cumbria wanted me to stop the T3 I was taking in addition to thyroxine & lower the dose of thyroxine I had previously been taking for several years,prior to adding T3.

I left & did not obey.I will be doing likewise if I meet the same brick wall of ignorance & lack of interest in anything that deviates from the dogma of the TSH & thyroxine.