Michaelsson Luba Freja, Medici Bjarke Borregaard, la Cour Jeppe Lerche, Selmer Christian, Røder Michael, Perrild Hans, Knudsen Nils, Faber Jens, Nygaard Birte
Department of Endocrinology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
Department of Endocrinology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark ; Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Eur Thyroid J. 2015 Sep;4(3):174-80. doi: 10.1159/000437262. Epub 2015 Aug 14.
Five to ten percent of patients with hypothyroidism describe persistent symptoms despite being biochemically well regulated on levothyroxine (L-T4). Thyroxine (T4)/triiodothyronine (T3) combination therapy [L-T4/liothyronine (L-T3) or desiccated thyroid] are still regarded as experimental with no evidence of superior effect on persistent symptoms according to meta-analyses. However, some randomized controlled trials have demonstrated patients' preference for T4/T3 combination therapy as compared to L-T4 monotherapy. In 2013, attention to combination therapy increased in Denmark after a patient published a book describing her experiences with hypothyroidism and treatment.
To investigate current Danish trends in the use of T4/T3 combination therapy.
We used an Internet-based questionnaire, distributed as a link via two Danish patient fora. Further, information was obtained from the Division of Pharmacies and Reimbursement at the Danish Health and Medicines Authority and from the only pharmacy in Denmark producing desiccated thyroid and L-T3 tablets.
A total of 384 patients answered the questionnaire, and 293 responders were included. Sixty-nine percent of the responders had six or more symptoms, and 84% reported a treatment effect. Forty-four percent of the responders received their prescriptions from general practitioners; 50% received desiccated thyroid and 28% reported that they adjust their dose themselves. Responders followed by general practitioners more frequently received desiccated thyroid and adjusted their dose themselves.
Increased media focus has changed the prescription pattern of thyroid hormones; European guidelines on T4/T3 combination therapy are not always followed in Denmark and many patients adjust their medication themselves and may therefore be at risk of overtreatment.
5%至10%的甲状腺功能减退患者表示，尽管左甲状腺素（L-T4）治疗在生化指标上已得到良好控制，但仍存在持续症状。甲状腺素（T4）/三碘甲状腺原氨酸（T3）联合治疗[L-T4/碘塞罗宁（L-T3）或干燥甲状腺片]仍被视为试验性治疗，根据荟萃分析，尚无证据表明其对持续症状有更好的疗效。然而，一些随机对照试验表明，与L-T4单药治疗相比，患者更倾向于T4/T3联合治疗。2013年，丹麦一名患者出版了一本描述其甲状腺功能减退及治疗经历的书后，对联合治疗的关注度有所增加。
调查丹麦目前使用T4/T3联合治疗的趋势。
我们使用了一份基于互联网的问卷，通过两个丹麦患者论坛以链接形式分发。此外，还从丹麦卫生和药品管理局的药房与报销部门以及丹麦唯一生产干燥甲状腺片和L-T3片剂的药房获取了信息。
共有384名患者回答了问卷，其中293名回答者被纳入研究。69%的回答者有六种或更多症状，84%的人报告有治疗效果。44%的回答者从全科医生处获得处方；50%的人使用干燥甲状腺片，28%的人报告自行调整剂量。由全科医生随访的回答者更常使用干燥甲状腺片并自行调整剂量。
媒体关注度的增加改变了甲状腺激素的处方模式；丹麦并不总是遵循欧洲关于T4/T3联合治疗的指南，许多患者自行调整用药，因此可能有过度治疗的风险。
