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Patients’ persistent symptoms, clinician demographics and geo-economic factors are associated with choice of therapy for hypothyroidism by European thyroid specialists: The “THESIS”* collaboration (*<i>T</i>reatment of <i>H</i>ypothyroidism in Europe by <i>S</i>pecialists, an <i>I</i>nternational <i>S</i>urvey)

2024; Mary Ann Liebert, Inc.; Linguagem: Inglês

10.1089/thy.2023.0580

1557-9077

Roberto Attanasio, Miloš Žarković, Enrico Papini, Endre V. Nagy, Roberto Negro, Petros Perros, Ersin Akarsu, Maria Alevizaki, Göksün Ayvaz, Tomasz Bednarczuk, Biljana Beleslin, Eszter Berta, Miklós Bodor, Anna-Maria Borissova, Mihail Boyanov, Camille Buffet, Maria‐Cristina Burlacu, Jasmina Ćirić, Juan J. Díez, Harald Dobnig, Valentin V. Fadeyev, Benjamin Field, Eric Fliers, Dagmar Führer, Juan Carlos Galofré, Tommi Hakala, Jan Jiskra, Peter Kopp, Michael Krebs, Michal Kršek, Martin Kužma, Mikael Lantz, Ivica Lazúrová, Laurence Leenhardt, Vitaliy Luchytskiy, Francisca Marques Puga, Anne McGowan, Saara Metso, Carla Moran, Tatyana Morgunova, D Niculescu, Božidar Perić, Tereza Planck, Cătălina Poiană, Eyal Robenshtok, Patrick Olivier Rosselet, Marek Ruchała, Kamilla Ryom Riis, Alla Shepelkevich, М.D. Тronko, David Unuane, Irfan Vardarli, W. Edward Visser, Andromachi Vryonidou, Younes Ramazan Younes, László Hegedűs,

Thyroid Cancer Diagnosis and Treatment

Background. Hypothyroidism is common, however, aspects of its treatment remain controversial. Our survey aimed at documenting treatment choices of European thyroid specialists and exploring how patients' persistent symptoms, clinician demographics, and geo-economic factors relate to treatment choices. Methods. 17,247 thyroid specialists from 28 countries were invited to participate in an online questionnaire survey. The survey included respondent demographic data and treatment choices for hypothyroid patients with persistent symptoms. Geo-economic data for each country were included in the analyses. Results. The response rate was 32.9% (6,058 respondents out of 17,247 invitees). Levothyroxine (LT4) was the initial treatment preferred by the majority (98.3%). Persistent symptoms despite normal serum thyrotropin (TSH) while receiving LT4 treatment were reported to affect up to 10.0% of patients by 75.4% of respondents, while 28.4% reported an increasing such trend in the past five years. The principal explanations offered for patients' persistent symptoms were psychosocial factors (77.1%), comorbidities (69.2%), and unrealistic patient expectations (61.0%). Combination treatment with LT4 + liothyronine (LT3) was chosen by 40.0% of respondents for patients who complained of persistent symptoms despite a normal TSH. This option was selected more frequently by female thyroid specialists, with high-volume practice, working in countries with high gross national income per capita. Conclusions. The perception of patients' dissatisfaction reported by physicians seems lower than that described by hypothyroid patients in previous surveys. LT4+LT3 treatment is used frequently by thyroid specialists in Europe for persistent hypothyroid-like symptoms even if they generally attribute such symptoms to non-endocrine causes and despite the evidence of non-superiority of the combined over the LT4 therapy. Pressure by dissatisfied patients on their physicians for LT3-containing treatments is a likely explanation. The association of the therapeutic choices with the clinician demographic characteristics and geo-economic factors in Europe is a novel information and requires further investigation.