Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55902, USA.
Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Medicina (Kaunas). 2020 Apr 3;56(4):161. doi: 10.3390/medicina56040161.
It is unclear why many patients with hypothyroidism prefer the use of desiccated thyroid extract (DTE) as a thyroid hormone replacement formulation over levothyroxine (LT4) treatment, as recommended by clinical practice guidelines. We analyzed patient-reported information from patient online forums to better understand patient preferences for and attitudes toward the use of DTE to treat hypothyroidism. We conducted a mixed-methods study by evaluating the content of online posts from three popular hypothyroidism forums from patients currently taking DTE ( = 673). From these posts, we extracted descriptive information on patient demographics and clinical characteristics and qualitatively analyzed posts' content to explore patient perceptions on DTE and other therapies further. Nearly half (46%) of the patients reported that a clinician initially drove their interest in trying DTE. Patients described many reasons for switching from a previous therapeutic approach to DTE, including lack of improvement in hypothyroidism-related symptoms (58%) and the development of side effects (22%). The majority of patients described DTE as moderately to majorly effective overall (81%) and more effective than the previous therapy (77%). The most frequently described benefits associated with DTE use were an improvement in symptoms (56%) and a change in overall well-being (34%). One-fifth of patients described side effects related to the use of DTE. Qualitative analysis of posts' content supported these findings and raised additional issues around the need for individualizing therapy approaches for hypothyroidism (e.g., a sense of each patient has different needs), as well as difficulties obtaining DTE (e.g., issues with pharmacy availability). Lack of individualized treatment and a feeling of not been listened to were recurrent themes among DTE users. A subset of patients may prefer DTE to LT4 for many reasons, including perceived better effectiveness and improved overall well-being, despite the risks associated with DTE.
目前尚不清楚为什么许多甲状腺功能减退症患者更喜欢使用甲状腺干制剂（DTE）作为甲状腺激素替代疗法，而不是遵循临床实践指南推荐使用左甲状腺素（LT4）治疗。我们通过分析患者在线论坛上的患者报告信息，以更好地了解患者对 DTE 治疗甲状腺功能减退症的偏好和态度。我们通过评估来自三个流行的甲状腺功能减退症论坛上正在服用 DTE 的患者的在线帖子内容（n=673）进行了混合方法研究。从这些帖子中，我们提取了患者人口统计学和临床特征的描述性信息，并对帖子内容进行了定性分析，以进一步探讨患者对 DTE 和其他疗法的看法。近一半（46%）的患者报告说，临床医生最初促使他们对尝试 DTE 感兴趣。患者描述了从之前的治疗方法转为 DTE 的许多原因，包括甲状腺功能减退症相关症状没有改善（58%）和出现副作用（22%）。大多数患者总体上描述 DTE 为中度至高度有效（81%），且比之前的治疗更有效（77%）。与使用 DTE 相关的最常描述的益处是症状改善（56%）和整体健康状况改善（34%）。五分之一的患者描述了与使用 DTE 相关的副作用。对帖子内容的定性分析支持了这些发现，并提出了围绕个体化甲状腺功能减退症治疗方法的其他问题（例如，每个患者都有不同的需求的感觉），以及获得 DTE 的困难（例如，药房供应的问题）。缺乏个体化治疗和不被倾听的感觉是 DTE 用户反复出现的主题。由于认为 DTE 的效果更好，整体健康状况改善，一部分患者可能更愿意选择 DTE 而不是 LT4，尽管 DTE 存在相关风险。
