AACE endocrinology and diabetes · 2025
Use of Thyroid Hormones in Patients with Hypothyroidism and Euthyroidism in the United States: American Association of Clinical Endocrinology International Collaboration with the THESIS Investigators.
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Eldeiry Leslie S, Attanasio Roberto, Hegedüs Laszlo, Negro Roberto, Papini Enrico, Perros Petros, Gharib Hossein, Nagy Endre Vezekenyi, Žarković Milos, Garber Jeffrey R
Аннотация
BACKGROUND/OBJECTIVE: The management of hypothyroidism has evolved over time as the development of new guidelines and formulations of thyroid hormone have become available.
METHODS: A survey of American Association of Clinical Endocrinology members in the United States examining the treatment of hypothyroidism, including questions about initial choice of therapy, use of liothyronine (LT3)-containing regimens, and use of thyroid hormones in hypothyroid and non-hypothyroid patients.
RESULTS: Survey links were opened by 387 of 4000 potential respondents and completed by 299 (7%). Respondents unanimously cited levothyroxine (LT4) as the initial treatment choice for hypothyroidism. Forty-seven percent indicated they would use thyroid hormones in patients with euthyroidism with infertility and elevated thyroid antibodies, with smaller numbers for goiter, depression, hypercholesterolemia, fatigue, and obesity. About 60% would consider combination LT4/LT3 in a patient with euthyroidism who does not feel well on treatment or has persistent symptoms. In contrast, a much smaller minority (16% for LT4/LT3 and 5% for desiccated thyroid extract) used such regimens to manage their own hypothyroidism. Persistent symptoms in treated patients with a normal TSH were most often attributed to psychosocial factors, unrealistic patient expectations, and comorbidities. Significant associations were identified between respondent demographics and treatment choices, most notably age, practice setting, and volume of patients with hypothyroidism.
CONCLUSIONS: LT4 monotherapy is overwhelmingly employed as first line therapy for hypothyroidism by U.S. clinicians. However, the high usage of thyroid hormones for patients whose symptoms were considered to be unrelated to hypothyroidism is at odds with current international guidelines for the management of hypothyroidism.
METHODS: A survey of American Association of Clinical Endocrinology members in the United States examining the treatment of hypothyroidism, including questions about initial choice of therapy, use of liothyronine (LT3)-containing regimens, and use of thyroid hormones in hypothyroid and non-hypothyroid patients.
RESULTS: Survey links were opened by 387 of 4000 potential respondents and completed by 299 (7%). Respondents unanimously cited levothyroxine (LT4) as the initial treatment choice for hypothyroidism. Forty-seven percent indicated they would use thyroid hormones in patients with euthyroidism with infertility and elevated thyroid antibodies, with smaller numbers for goiter, depression, hypercholesterolemia, fatigue, and obesity. About 60% would consider combination LT4/LT3 in a patient with euthyroidism who does not feel well on treatment or has persistent symptoms. In contrast, a much smaller minority (16% for LT4/LT3 and 5% for desiccated thyroid extract) used such regimens to manage their own hypothyroidism. Persistent symptoms in treated patients with a normal TSH were most often attributed to psychosocial factors, unrealistic patient expectations, and comorbidities. Significant associations were identified between respondent demographics and treatment choices, most notably age, practice setting, and volume of patients with hypothyroidism.
CONCLUSIONS: LT4 monotherapy is overwhelmingly employed as first line therapy for hypothyroidism by U.S. clinicians. However, the high usage of thyroid hormones for patients whose symptoms were considered to be unrelated to hypothyroidism is at odds with current international guidelines for the management of hypothyroidism.