German doctors' prescribing T4 or combination therapy

[diogenes]

  I thought this might be interesting as a study on the practices of German Thyroidologists

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· 

   May 2022·      

 Experimental and Clinical Endocrinology & Diabetes 130(09)·      

 DOI: ·     10.1055/a-1832-0644    

Abstract

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.

[Lunario]

Thanks for sharing.

Interesting, after all, almost half see the need to prescribe LT3 as well (which is quite encouraging). You just have to find "the right one" when looking for such an expert. Presumably, it is precisely those who no longer admit you as a new patient. Many specialist practices are hopelessly overcrowded.

[TSH110]

much better than here but still less than half are using combination therapy

[Lunario in reply to TSH110]

I agree. I think there is still a lot of educational work to be done to raise awareness.

[TiggerMe]

Is it roughly known what ratio of Hypo's who likely need a combo approach as opposed to T4 only?

I don't know how much of a minority we are.... or are made out to be?

[loueldhen in reply to TiggerMe]

It's generally thought to be between 10-15%.

[TSH110 in reply to loueldhen]

It’s pulled out of a hat like a rabbit - the magic 10-15% - more like 99.9% I’d say

[Marz in reply to TiggerMe]

Due to poor diagnostic testing I doubt if they know how many hypos there really are - let alone know of those needing both T4 and T3 😢

[jgelliss in reply to Marz]

Marz it's so exciting and wonderful to see your post. Hope you and hubby are doing well.❤

[Marz in reply to jgelliss]

Thank you ! Doing just fine ! Hope you are too 🌈

[jgelliss in reply to Marz]

Miss your wonderful posts.

[Marz in reply to jgelliss]

Eyes not good after surgery and follow-up laser treatment so yes eyes tire easily.... SIGH x

[jgelliss in reply to Marz]

So sorry to hear it. Wishing you better days ahead. 😘

[TSH110 in reply to Marz]

Hope that soon improves.

[TSH110 in reply to TiggerMe]

given T4 does not appear to normalise thyroid hormones, I’d say everyone should get combination therapy - that’s what our thyroid gave us before it packed up. It should be personal choice what we take, not being treated like children with the decision taken for us and forced to take T4 and made ill for life. We are adults and perfectly able to decide what suits us best, it’s a scandal that endocrinologists and GP’s persist in infantilising us. If we were allowed to chose our thyroid hormone therapy it would soon be clear who needs what. What are they afraid of? The truth?

[BB001]

Encouraging that nearly half (45.4% ) use T3 as well as T4.

[technogran]

Yes I was on Liothyronine and reduced Levothyroxine. I went hyperthyroid and the consultant suggested I stay on the Lio and reduce futher the Levothyroxine. I might have tried this but because I have acid reflux I cannot tolerate taking the Lio on an empty stomach.. It may be a good idea for some but it takes fine tuning and quite frankly, aged 76, life is too short so I am going back to my former dose of just Levothyroxine. I must report that being hyper spoiled my Christmas so at the very least you must have a sympathetic consultant responsive to your needs and one that actually believes you,. Good luck.

[loueldhen in reply to technogran]

I had acid reflux for years. Gluten free/grain free. Reflux went away in days together with a persistent cough.

[BB001 in reply to technogran]

Recently it's been found if you take liothyronine with food it changes it from quick acting T3 to slow release T3 and reduces the peak.

As acid reflux is due to weakness of the muscle at the top of the stomach and can be a symptom of hypothyroidism, I would have taken your consultants advice and increased liothyronine and reduced levothyroxine. However, I would take all my liothyronine with food to make it slow release.

Now if I could only remember where I read about the impact on food on T3 medication...