Use of thyroid hormones in hypothyroid and euthyroid patients: a THESIS* survey of Belgian specialists

[helvella]

Asking the professionals what medicine they prefer seems like an extreme example of cart-before-horse.

Saying "Psychosocial factors were highlighted as the main contributors to persistent symptoms." is plainly ridiculous. If they have persistent symptoms, then help to address them. If they are psychosocial, then use the techniques of psychosocial medicine to help the patients. Don't just observe them and walk off.

I have lots of time for considering whether formulation and medicinal forms of levothyroxine are causing issues. Most obviously when absorption or the effects of excipients are the causative factors. But expecting soft gel or liquid forms to achieve miraculous resolution of symptoms is daft. Looks like a round of Titanic deckchair-shuffling.

Research. Open Access. Published: 05 March 2022

Use of thyroid hormones in hypothyroid and euthyroid patients: a THESIS* survey of Belgian specialists *THESIS: treatment of hypothyroidism in Europe by specialists: an international survey

• Maria-Cristina Burlacu,

• Roberto Attanasio,

• Laszlo Hegedüs,

• Endre V. Nagy,

• Enrico Papini,

• Petros Perros,

• Kiswendsida Sawadogo,

• Marie Bex,

• Bernard Corvilain,

• Chantal Daumerie,

• Brigitte Decallonne,

• Damien Gruson,

• Bruno Lapauw,

• Rodrigo Moreno Reyes,

• Patrick Petrossians,

• Kris Poppe,

• Annick Van den Bruel &

• David Unuane

Thyroid Research volume 15, Article number: 3(2022) Cite this article

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Abstract

Background

Hypothyroidism is a topic that continues to provoke debate and controversy with regards to specific indications, type of thyroid hormone substitution and efficacy. We investigated the use of thyroid hormones in clinical practice in Belgium, a country where currently only levothyroxine (LT4) tablet formulations are available.

Method

Members of the Belgian Endocrine Society were invited to respond to an online questionnaire. Results were compared with those from other THESIS surveys.

Results

Eighty (50%) of the invited 160 individuals, completed the questionnaire. LT4 was the first treatment of choice for all respondents. As secondary choice, some also prescribed liothyronine (LT3) and LT4 + LT3 combinations (2 and 7 respondents, respectively). Besides hypothyroidism, 34 and 50% of respondents used thyroid hormones for infertile euthyroid TPOAb positive women and the treatment of a growing non-toxic goiter, respectively. Had alternative formulations of LT4 to tablets been available (soft gel or liquid L-T4), 2 out of 80 (2.5%) participants would consider them for patients achieving biochemical euthyroidism but remaining symptomatic. This proportion was higher in case of unexplained poor biochemical control of hypothyroidism (13.5%) and in patients with celiac disease or malabsorption or interfering drugs (10%). In symptomatic euthyroid patients, 20% of respondents would try combined LT4 + LT3 treatment. Psychosocial factors were highlighted as the main contributors to persistent symptoms.

Conclusions

LT4 tablets is the preferred treatment for hypothyroidism in Belgium. A minority of the respondents would try combined LT4 + LT3 in symptomatic but biochemically euthyroid patients. Thyroid hormones are prescribed for euthyroid infertile women with thyroid autoimmunity and patients with non-toxic goiter, a tendency noted in other European countries, despite current evidence of lack of benefit.

Open access to full paper here:

thyroidresearchjournal.biom...

[greygoose]

We investigated the use of thyroid hormones in clinical practice in Belgium, a country where currently only levothyroxine (LT4) tablet formulations are available.

Surely that's not true, is it? I used to buy my Armour in Belgium.

[helvella Administrator Thyroid UK in reply to greygoose]

From what has been posted here, yes. Some doctors do prescribe desiccated thyroid - I think it possible to get Armour and Erfa.

But no T3. If anyone needs it, somehow it has to come from outside Belgium.

[greygoose in reply to helvella]

Yes, I know they don't have T3, but they do have NDT. So, it's not true to say that only levo is available.

[helvella Administrator Thyroid UK in reply to greygoose]

I suspect it is a bit like here - not listed and readily available at any pharmacy.

[tattybogle]

If the Members of the Belgian Endocrinology Society are anything like the members of the UK endocrinology society... how would they even know what someone's psychosocial factors were when they barely manage to find time in a @10 minute appointment to even ask "How do you feel ?"

I though you had to talk to people for rather more than 2 minutes to find out what their characteristics and life were really like ?

Or is "your referral letter implies your doctor and your husband think you are an attention seeking nuisance" now considered a valid psychosocial 'factor' ?

[Hennerton]

Sadly a total waste of time but they will pat themselves on the back, comfortably thinking that they are doing their best for thyroid patients.

[TSH110]

I’d call this a ‘don’t listen to the patient’ paper