What the Germans do

[diogenes]

This is a questionnaire about T4 and T3 dosing in Germany. It seems they prescribe much as in the UK. It's available in full

Exp Clin Endocrinol Diabetes 
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,

Tim Brandenburg

Laszlo Hegedüs

Roberto Attanasio

EndreV. Nagy

,Enrico Papini

Petros Perros

Frank Weidemann

Ken Herrmann

Dagmar Führer

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.

Link: thieme-connect.com/products...

[Link added by admin]

[amala57]

I wonder if they ever use dessicated thyroid gland?

[helvella Administrator Thyroid UK in reply to amala57]

When I was collecting information for my thyroid treatment history, German companies regularly appeared as manufacturers and suppliers of desiccated thyroid. They appear to have done much as we in the UK did - switch over to levothyroxine and drop desiccated thyroid products.

helvella - Historical Context of Thyroid Treatment in the UK

Extracts of possible interest mostly from The Chemist and Druggist. These documents are currently still being developed.

Pre-1900 document

From Dropbox:

dropbox.com/s/h9mul6hdfqfew...

From Google Drive:

drive.google.com/file/d/1I4...

1900-1949 document

From Dropbox:

dropbox.com/s/a2wd7agpfcrcj...

From Google Drive:

drive.google.com/file/d/1iE...

1950-1999 document

From Dropbox:

dropbox.com/s/barcg7h4uj2nm...

From Google Drive:

drive.google.com/file/d/1ZO...

2000 onwards

From Dropbox:

dropbox.com/s/dwgrmoxqj24el...

From Google Drive:

drive.google.com/file/d/1gG...

[TSH110 in reply to amala57]

There’s a compounding chemist there that supplies it so clearly it’s available here tge details:

Thyreogland

Supplied by the Klösterl-Apotheke Munich

Klösterl-Apotheke
Postfach 10 09 05 • 80083 München • GERMAN

AVAILABLE STRENGTHS

Thyreogland is available in the following dosages (according to the natural content of levothyroxine in mcg):
5 / 10 / 15 / 20 / 25 / 30 / 40 / 50 / 60 / 70 / 75 / 80 / 100

“Thyreogland” contains the thyroid hormones levothyroxine (T4) and liothyronine (T3) at the ratio T4: T3 = ca. 4 : 1.

[Armour and Nature Throid have a ratio of 4.2]. E.g. Thyreogland 40 contains 40 mg of T4 and 10 mg of T3 - this is the closest to 1 grain NDT.

[amala57 in reply to TSH110]

Thanks this is really helpful.

[RedApple Administrator]

'German thyroid specialists prefer LT4 tablets rather than other LT4 formulations, such as liquid or soft-gel capsules'

Never mind what the patient prefers, it's what the prescriber prefers that matters! 😡

[helvella Administrator Thyroid UK]

A quick look did not notice mention of the combined LT4 + Iodine (Jod) which is available in Germany. Though they do mention iodine and selenium supplementation.

[Brightness14]

Off subject first port of call for UK and French GP's for slightly high BP is medication. In Germany the GP's prescribe Hawthorn capsules, these work too. Germans in general use more natural products as a first line of defence.