Portugese doctors' use of T4 and T3 therapy

[diogenes]

 A look now at Portugese doctors' treatment of hypothyroidism. They are much less likely to prescribe combination therapy, but many would consider it if the patient did not improve on T4 only. They aren't interested in the source of T4.

Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients: A THESIS Questionnaire Survey of Portuguese Endocrinologists

 Francisca Marques Puga a,*, Helder Simões b, Miguel Melo c, Roberto Attanasio d, Laszlo Hegedüs e, Endre V. Nagy f, Enrico Papini i, Petros Perros h, Cláudia Freitas i a Endocrinology, Diabetes and Metabolism Service, Porto Hospital and University Centre, Porto, Portugalb Endocrinology Service, Portuguese Oncology Institute of Lisbon; Nova Medical School of New Lisbon University, Lisboa, Portugalc Endocrinology, Diabetes and Metabolism Service, Coimbra University and Hospital Centre; Medical School of Coimbra University, Coimbra, Portugald Associazione Medici Endocrinologi & International Chapter of Clinical Endocrinology, Italye Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Odense, Denmarkf Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungaryg Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano, Rome, Italy Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdomi Endocrinology, Diabetes and Metabolism Service, Porto Hospital and University Centre; Abel Salazar Biomedical Sciences Institute of Porto University,

 Rev Port Endocrinol Diabetes Metab. 2022;17(1-2) 

 A B S T R A C T I

Introduction: 

The standard treatment of hypothyroidism is levothyroxine (LT4), which is available only as tablets in Portugal. This study was part of the European study THESIS (Treatment of Hypothyroidism in Europe by Specialists: an International Survey) and aimed to investigate Portuguese endocrinologists’ use of thyroid hormones in hypothyroid and euthyroid patients. Material and Methods: 

An e-mail with an invitation to participate in an online survey investigating practices about substitution with thyroid hormones was sent to all physician members of the Portuguese Society of Endocrinology, Diabetes and Metabolism (SPEDM).Results: Out of 391 eligible SPEDM members, a total of 106 (27.1%) respondents were included in the analysis. The majority (97.2%) used LT4 as the treatment of choice for hypothyroidism. In various conditions that could interfere with LT4 absorption, most respondents (68.0% - 94.3%) preferred tablets and did not expect a significant difference when switching from one type of LT4 formulation to another. Other treatment options for hypothyroidism, such as combination therapy with LT4 and liothyronine (LT3) were rarely used (2.8%). However, the majority of Portuguese physicians (66%) would consider LT4 + LT3 combination in cases of persistent symptoms of hypothyroidism despite biochemical control. Over half of the respondents answered that thyroid hormone therapy is never indicated for euthyroid patients, but 34.9% and 22.6% would consider it for euthyroid infertile women with high anti-thyroid antibody levels and in cases of euthyroid simple growing goiter, respectively. Discussion and Conclusion: The treatment of choice for hypothyroidism in Portugal is LT4. Combina- tion therapy with LT4 + LT3 would be considered by the majority of respondents for patients with persis- tent symptoms. Some endocrinologists would offer LT4 to euthyroid infertile woman with high antibody levels and to euthyroid patients with progressively growing simple goiter, contrary to current evidence.

 doi.org/10.26497/ao200050   

[helvella Administrator Thyroid UK]

I see that two LT3 products have appeared on the Portuguese medicines site since last I checked.

Screenshot of available LT3 products in Portugal

[helvella Administrator Thyroid UK in reply to helvella]

However, the reason I saw them was because of how I searched. Now I look again, the authorisations for both were withdrawn (5 microgram in 2003, 25 microgram in 21013).

Therefore, I go back and say that to the best of my knowledge there is no authorised LT3 product in Portugal. If needed, I think it will likely be a special import from France or Germany.

[Alanna012 in reply to helvella]

Why are authorisations for standard drug formulation s like liothyronine withdrawn?

[helvella Administrator Thyroid UK in reply to Alanna012]

There are two obvious directions for this:

First, the company decides not to manufacture and/or market it any longer in the country. Maybe not enough profit? Sometimes the medicine becomes an "orphan" drug - available for a tiny number of patients.

Second, the authorities decide it is not acceptable any longer. Could just be they decide a particular active ingredient should not be sold. (Obvious example was thalidomide when all products were withdrawn.) Or the factory doesn't conform to standards, or the product doesn't conform to standards.

However, across all medicines, there are other possibilities. Like France banning desiccated thyroid by law.

[TSH110 in reply to helvella]

so much for liberte egalite fraternite