Patients’ persistent symptoms, clinician demographics and geo-economic factors are associated with choice of therapy for hypothyroidism by European thyroid specialists: The “THESIS”* collaboration (*reatment of ypothyroidism in Europe by pecialists, an nternational urvey).

Feb 19, 2024

Experts: Roberto Attanasio, Miloš Žarković, Enrico Papini, Endre V Nagy, Roberto Negro, Petros Perros, Ersin Akarsu, Maria Alevizaki, Göksun Ayvaz, Tomasz Bednarczuk, Biljana Beleslin, Eszter Berta, Miklos Bodor, Anna Maria Borissova, Mihail Boyanov, Camille Buffet, Maria-Cristina Burlacu, Jasmina Ciric, Juan J Díez, Harald Dobnig, Valentin V Fadeyev, Benjamin Ct Field, Eric Fliers, Dagmar Führer, Juan Carlos Galofré, Tommi Hakala, Jan Jiskra, Peter A Kopp, Michael Krebs, Michal Kršek, Martin Kuzma, Mikael Lantz, Ivica Lazúrová, Laurence Leenhardt, Vitaliy Luchytskiy, Francisca Marques Puga, Anne McGowan, Saara Metso, Carla Moran, Tatyana Morgunova, Dan Alexandru Niculescu, Božidar Perić, Tereza Planck, Catalina Poiana, Eyal Robenshtok, Patrick Olivier Rosselet, Marek Ruchala, Kamilla Ryom Riis, Alla Shepelkevich, Mykola D Tronko, David Unuane, Irfan Vardarli, W Edward Visser, Andromachi Vryonidou, Younes Ramazan Younes, Laszlo Hegedus

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.
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.
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.
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.

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ABOUT THE EXPERTS

Roberto Attanasio, Miloš Žarković, Enrico Papini, Endre V Nagy, Roberto Negro, Petros Perros, Ersin Akarsu, Maria Alevizaki, Göksun Ayvaz, Tomasz Bednarczuk, Biljana Beleslin, Eszter Berta, Miklos Bodor, Anna Maria Borissova, Mihail Boyanov, Camille Buffet, Maria-Cristina Burlacu, Jasmina Ciric, Juan J Díez, Harald Dobnig, Valentin V Fadeyev, Benjamin Ct Field, Eric Fliers, Dagmar Führer, Juan Carlos Galofré, Tommi Hakala, Jan Jiskra, Peter A Kopp, Michael Krebs, Michal Kršek, Martin Kuzma, Mikael Lantz, Ivica Lazúrová, Laurence Leenhardt, Vitaliy Luchytskiy, Francisca Marques Puga, Anne McGowan, Saara Metso, Carla Moran, Tatyana Morgunova, Dan Alexandru Niculescu, Božidar Perić, Tereza Planck, Catalina Poiana, Eyal Robenshtok, Patrick Olivier Rosselet, Marek Ruchala, Kamilla Ryom Riis, Alla Shepelkevich, Mykola D Tronko, David Unuane, Irfan Vardarli, W Edward Visser, Andromachi Vryonidou, Younes Ramazan Younes, Laszlo Hegedus

Roberto Attanasio

Associazione Medici Endocrinologi, Scientific Committee, via Compagnoni 1, Milan, Italy, 20129; roberto.serena@libero.it.

Miloš Žarković

University of Belgrade Faculty of Medicine, 119081, Beograd, Serbia; milos.zarkovic@gmail.com.

Enrico Papini

Regina Apostolorum Hospital, 220435, Endocrinology, Metabolism and Digestive Disease, Albano Laziale, Italy; papinie@gmail.com.

Endre V Nagy

University of Debrecen, Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology, Nagyerdei krt 98, Debrecen, Hungary, 4032; nagy@internal.med.unideb.hu.

Roberto Negro

“V. Fazzi” Hospital, Endocrinology, Lecce, Italy; dr.negro@libero.it.

Petros Perros

Newcastle University, Institute of Translational and Clinical Research, Newcastle upon Tyne, Newcastle upon Tyne , United Kingdom of Great Britain and Northern Ireland; petros.perros@newcastle.ac.uk.

Ersin Akarsu

Gaziantep University Faculty of Medicine, Endocrinology and Metabolism, Gaziantep, Turkey; ersinakrs@hotmail.com.

Maria Alevizaki

National and Kapodistrian University of Athens School of Medicine, 68989, Endocrine Unit, Dept Clinical Therapeutics, Athens, Attica, Greece.

Alexandra Hospital, Endocrinology and Metabolism, Athens, Greece; mani@otenet.gr.

Göksun Ayvaz

Koru Ankara Hospital, Department of Endocrinology and Metabolism, Çankaya/Ankara, Turkey; goksunayvaz@gmail.com.

Tomasz Bednarczuk

Medical University of Warsaw, Department of Endocrynology, Banacha 1A, Warsaw, Poland, 02-097; tomasz.bednarczuk@wum.edu.pl.

Biljana Beleslin

University of Belgrade Faculty of Medicine, 119081, C2, Beograd, Serbia; biljana_beleslin@yahoo.com.

Eszter Berta

University of Debrecen, Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology, Debrecen, Hungary; berta.eszter@med.unideb.hu.

Miklos Bodor

University of Debrecen, 37599, Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Debrecen, Hajdú-Bihar, Hungary; bodor.miklos@med.unideb.hu.

Anna Maria Borissova

University Hospital Sofiamed, 598565, Clinic of Endocrinology and Metabolism, Sofia, Bulgaria.

Sofia University “Saint Kliment Ohridski”, Medical Faculty, Sofia, Bulgaria; anmarbor@abv.bg.

Mihail Boyanov

University Hospital Alexandrovska, 58788, Clinic of Endocrinology and Metabolism, Sofia, Bulgaria.

Medical University-Sofia, 58789, Department of Internal Medicine, Sofia, Bulgaria; mihailboyanov@yahoo.com.

Camille Buffet

Sorbonne Université, 27063, GRC n 16, GRC Thyroid Tumors, Paris, France.

Hôpital Pitié-Salpêtriére, Thyroid Disease and Endocrine Tumor Department, Paris, France; camille.buffet@aphp.fr.

Maria-Cristina Burlacu

Université catholique de Louvain Secteur des sciences de la santé, 193391, Department of Endocrinology Diabetology and Nutrition, Cliniques Universitaires St-Luc, Bruxelles, Belgium; maria.burlacu@uclouvain.be.

Jasmina Ciric

Institute for endocrinology, diabetes and metabolic disorders , Belgrade, Serbia.

Medical Faculty, University of Belgrade, Belgrade, Serbia; jasminaciric1005@gmail.com.

Juan J Díez

Hospital Universitario Puerta de Hierro Majadahonda, 16370, Department of Endocrinology and Nutrition, Majadahonda, Spain.

Universidad Autónoma de Madrid, 16722, Department of Medicine, Madrid, Spain; juanjose.diez@salud.madrid.org.

Harald Dobnig

Thyroid and Osteoporosis Praxis, Kumberg, Austria.

Thyroid Practice for Radiofrequency Ablation, Vienna, Austria; harald.dobnig@hormoninstitut-dobnig.at.

Valentin V Fadeyev

I.M. Sechenov 1st Moscow State Medical University, Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, Moscow, Russian Federation; walfad@mail.ru.

Benjamin Ct Field

University of Surrey, 3660, Section of Clinical Medicine, Faculty of Health & Medical Sciences, Guildford, United Kingdom of Great Britain and Northern Ireland; benjamin.field@nhs.net.

Eric Fliers

University of Amsterdam, 1234, 19Department of Endocrinology & Metabolism, Amsterdam UMC, Amsterdam, Netherlands; e.fliers@amsterdamumc.nl.

Dagmar Führer

University Hospital Essen, Department of Endocrinology, Diabetes and Metabolism, Essen, Germany; dagmar.fuehrer-sakel@uk-essen.de.

Juan Carlos Galofré

University of Navarra Clinic, 16755, Endocrinology, Avda. Pio XII, 36, Pamplona, Spain, 31008; jcgalofre@unav.es.

Tommi Hakala

Tampere University Hospital, 60670, Department of Surgery, Tampere, Finland; Tommi.Hakala@pshp.fi.

Jan Jiskra

1st Faculty of Medicine, Charles University, General University Hospital, 3rd Department of Medicine, U Nemocnice 1, Prague, Czech Republic, 128 08; jan.jiskra@vfn.cz.

Peter A Kopp

University of Lausanne, 27213, Division of Endocrinology, Diabetes and Metabolism, Lausanne, Switzerland; p-kopp@northwestern.edu.

Michael Krebs

Medical University of Vienna, 27271, Internal Medicine III, Division of Endocrinology and Metabolism, Wien, Austria; michael.krebs@meduniwien.ac.at.

Michal Kršek

1st Faculty of Medicine, Charles University, General University Hospital, 3rd Department of Medicine, Prague, Czech Republic; krsek.michal@gmail.com.

Martin Kuzma

5th Department of Internal Medicine, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia; kuzma.martin1@gmail.com.

Mikael Lantz

Skåne University Hospital, Department of Clinical Sciences, Diabetes & Endocrinology, Malmö, Sweden; mikael.lantz@med.lu.se.

Ivica Lazúrová

P.J. Šafárik University Košice, 1st Department of Internal Medicine of the Medical Faculty, Košice, Slovakia; ivica.lazurova@upjs.sk.

Laurence Leenhardt

Assistance Publique – Hopitaux de Paris, 26930, Thyroid and Endocrine Tumors Unit, Endocrinology Institute, Pitié Hospital 83 Bd de l’Hopital, Paris, Île-de-France, France, 75013; laurence.leenhardt@aphp.fr.

Vitaliy Luchytskiy

National Academy of Medical Sciences of Ukraine, 123493, Department of Reproductive Endocrinology, Institute of Endocrinology and Metabolism named after V.P. Komissarenko, Kiiv, Ukraine; vitaliyluchytskiy@gmail.com.

Francisca Marques Puga

Centro Hospitalar Universitário de Santo António, 112085, Endocrinology, Diabetes and Metabolism Service, Porto, Portugal; francisca_puga17@icloud.com.

Anne McGowan

Tallaght University Hospital, 57976, Robert Graves Institute, Dublin, Ireland; anne.mcgowan@tuh.ie.

Saara Metso

Tampere University Hospital, 60670, Department of Endocrinology, Tampere, Finland; saara.metso@pirha.fi.

Carla Moran

Beacon Hospital, 63860, Diabetes & Endocrinology Section, Sandyford, Ireland.

University College Dublin, 8797, School of Medicine, Dublin, Ireland; carla.moran@ucd.ie.

Tatyana Morgunova

I.M. Sechenov 1st Moscow State Medical University, Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, Moscow, Russian Federation; tanmorgun@mail.ru.

Dan Alexandru Niculescu

Carol Davila University of Medicine and Pharmacy, Department of Endocrinology, Bucharest, Romania; dan.niculescu@umfcd.ro.

Božidar Perić

University Hospital Center “Sisters of Mercy”, Department of Endocrinology, Diabetes and Metabolic Diseases “Mladen Sekso”, Zagreb, Croatia; bozperic@yahoo.com.

Tereza Planck

Skåne University Hospital, Department of Clinical Sciences, Diabetes & Endocrinology, Malmo, Sweden; tereza.planck@med.lu.se.

Catalina Poiana

Carol Davila University of Medicine and Pharmacy, Department of Endocrinology, Bucharest, Romania; endoparhon@gmail.com.

Eyal Robenshtok

Tel Aviv University, 26745, Sackler Faculty of Medicine, Tel Aviv, Israel.

Beilinson Hospital and Davidoff Cancer Center, Rabin Medical Center, Thyroid Cancer Service, Endocrinology and Metabolism Institute, Petah Tikva, Israel; robensht@gmail.com.

Patrick Olivier Rosselet

Cabinet Médical 2, Lausanne, Switzerland; po.rosselet@hotmail.com.

Marek Ruchala

University of Medical Sciences, The Department of Endocrinology, Metabolism and Internal Medicine, ul.Przybyszewskiego 49, Poznañ, Poland, 60-355.

Poland; mruchala@ump.edu.pl.

Kamilla Ryom Riis

Odense University Hospital, Department of Endocrinology and Metabolism, Odense, Denmark; kamilla.ryom.riis@gmail.com.

Alla Shepelkevich

Belarusian State Medical University, Department of Endocrinology, Minsk, Belarus; alla.shepelkevich@mail.ru.

Mykola D Tronko

State Institution “V.P.Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine”, Department of Fundamental and Applied Problems of Endocrinology, 69 Vyshegorodskaya Str., Kyiv 04114, Ukraine; m.tronko@dccie.kiev.ua.

David Unuane

Universitair Ziekenhuis Brussel, Endocrinology, Laarbeeklaan 101, 1090 Brussels, Brussels, Belgium, 1090; david.unuane@uzbrussel.be.

Irfan Vardarli

Klinikum Vest GmbH, Knappschaftskrankenhaus Recklinghausen, Academic Teaching Hospital, Ruhr-University Bochum, Department of Medicine I, Dorstener Str. 151, Recklinghausen, Germany, 45657.

United States; irfan.vardarli@alumni.uni-heidelberg.de.

W Edward Visser

University Medical Center Rotterdam , Thyroid Laboratory, Wytemaweg 80, Rotterdam, Netherlands, 3015 GE; w.e.visser@erasmusmc.nl.

Andromachi Vryonidou

Hellenic Red Cross Hospital, Department of Endocrinology and Diabetes, Athens, Greece; mahi_vr@hotmail.com.

Younes Ramazan Younes

East Surrey Hospital, 156670, Redhill, Surrey, United Kingdom of Great Britain and Northern Ireland; ramazan.younes@nhs.net.

Laszlo Hegedus

Odense University Hospital, Department of Endocrinology and Metabolism, Kloevervaenget 6, 6th floor, Odense, Denmark, 5000; Laszlo.Hegedus@rsyd.dk.