Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients: A THESIS questionnaire survey of members of the Irish Endocrine Society
Mohamad Mustafa1 · Elsheikh Ali1 · Anne McGowan1 Roberto Attanasio4 · Endre V. Nagy5 · Enrico Papini6, Laura McCabe2 · Laszlo Hegedüs3 · · Petros Perros7 · Carla Moran8,9
Abstract
Background
of thyroid hormones (TH) with Levothyroxine (LT4) is the treatment of choice for hypothyroid- ism, however, there are aspects of treatment where uncertainties exist and practice varies. Factors influencing initiation and choice of TH replacement may impact patient satisfaction, safety, and health care costs.Methods The aim of the study was to examine the attitudes of Irish endocrinologists regarding the treatment of hypothyroid and euthyroid patients with TH. Members of the Irish Endocrine Society (IES) were invited to participate in an online survey. Results Forty-eight invitations were sent, and 39 (81.3%) participants responded. All respondents favoured LT4 tablet therapy for treatment of hypothyroidism, but 20.5% prescribed combination therapy (LT4 and liothyronine), and 13% regularly used desiccated thyroid extract. A significant proportion (51%) might prescribe TH in euthyroid patients; 41% for thyroid auto-antibody positive women seeking pregnancy, 18% for goitre and 5% for unexplained fatigue. Many (38%) consider combination therapy in patients with persistent symptoms. Respondents reported seeing LT4 treated patients with persistent symptomatology more frequently and perceive psychosocial factors and comorbidities to be the most common reasons for such LT4 tablets are the treatment of choice for hypothyroidism in Ireland.
Conclusion Approximately a third of Irish endocrinologists either regularly use, or would consider, liothyronine for hypothyroid patients. A significant proportion would give TH to euthyroid individuals in specific circumstances. The prescription of TH amongst Irish endocrinologists was generally in keeping with recommended practice, and areas where practice deviated from guidance were typically where evidence was conflicting or insufficient.
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Thank you for this, very useful but somewhat worrying as intend to move back home to Ireland in next couple of years. With only 47 endocrinologists as mentioned in the report it will be a whole other set of problems .
I have read you can ask at pharmacies if they issue prescriptions for it not, sure if you could then narrow it down to the relevant practice /GP. There’s a prescribing register by local health authority here in U.K. so you can see where T3 is being prescribed but I don’t know if such a prescribing register exists for Ireland.
This article about the attitudes of endocrinologists is unfortunately an accurate reflection of the attitude of medical professionals to thyroid patients ( in the same way that menopausal patients have been treated historically) and the standard of care provided.
The health system in Ireland has been crumbing for over a decade and unfortunately it never had the underlying ethos of the NHS. There have been some positive initiatives in recent years but too few and much too slowly implemented.
If you do move to Ireland and haven't found a GP or endo to prescribe T3 please feel free to pm me and I can share the contact details of a GP who has a special interest in thyroid health and who prescribes T3.
I have recently been making enquiries in Ireland about the issue of T3. I have had a bit of conflicting information. Most pharmacists seem to think that there would not be much problem getting liothyronine if I was already on it and stable. However, one Gp recently out of Gp training said she didn’t think anyone would issue it as, and I’m fairly sure, she said they were trained not to. This was a few months back, so can’t recall her exact words but that was the impression I got.
The bigger problem over there would be actually getting a GP.
My thyroid issues are my biggest worry moving back to Ireland, the nhs has it”s flaws but it’s a whole lot betrothal the healthcare in Ireland where I will need to pay 50 euro each time I see a gp and pay for prescriptions- the only discount is a specific card that allows you to pay a max of 100 euro a month for meds. Not much fun getting older and trying to incorporate management of thyroid into the retirement plans
Thank you. For people who are unemployed /low income they can get what is known as a medical card but as I’ve lived here in uk for 35 years I won’t be entitled to any help. I will work something out. All of us thyroid sufferers are used to battling 😇
'The majority of physicians indicated (strongly agree or agree) that key factors included psychosocial factors (34/39, 87%), comorbidities (27/38, 71%), chronic fatigue syndrome (20/39, 51%) and unrealistic patient expectations (22/39, 56%) as most likely causes for persistent symptoms. Two thirds (26/39, 67%) did not agree (strongly disagree, disagree) that symptoms may be due to the inability of levothyroxine to restore normal physiology and 56% (22/39) disagreed that the presence of underlying inflammation causes persistent symptoms'
🙆♀️
'.... a study from 2014 showed that 6% of people newly prescribed LT4 in the UK had a serum TSH within the normal range prior to treatment [40], with the equivalent figure in the USA being 28% [41].'
What about Central hypothyroidism? Have these been taken into account?
'Most disagreed with the statement that LT4 does not restore normal physiology.'
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T4 & T3 combination therapy... day 9... awesome! 
Studies on TSH for those on combined T3 T4 therapy 
Why the Hesitancy in Recommending Combination T3/T4 Therapy?
