Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland.
Endocrinology Service, IRCCS Orthopaedic Institute Galeazzi, Milan, Italy.
Endokrynol Pol. 2021;72(4):357-365. doi: 10.5603/EP.a2021.0048. Epub 2021 May 19.
Over the past several years new evidence on the management of hypothyroidism has emerged, which has influenced recommendations from professional bodies. The presentation of hypothyroid patients has also changed, and new cases are increasingly diagnosed by indiscriminate screening, often identifying cases with minor biochemical disturbances. Little is known about the physician responses and attitudes to this changing landscape. THESIS (Treatment of Hypothyroidism in Europe by Specialists: an International Survey) is a large-scale survey of European physicians who treat patients with hypothyroidism. Here we document current practices of Polish physicians relating to the use of thyroid hormones in hypothyroid and euthyroid patients.
Members of the Polish Society of Endocrinology were invited to participate in the web-based THESIS survey.
In total 423 (54.6% of the 774 invited) physicians completed the survey. The majority of respondents (74.2%) would prescribe thyroid hormones foreuthyroid patients for certain indications, such as female infertility with elevated thyroid antibodies (63.4%), simple goitre (40.9%), unexplained fatigue (12.1%), obesity (9.7%), hypercholesterolaemia (9.0%), and depression (9.2%). Nearly all physicians (96.0%) declared that the treatment of choice for hypothyroidism is levothyroxine (LT4). However, around one-third (30.3%) were also using LT4 and liothyronine (LT3) combination treatment; LT3 alone was rarely prescribed (1.7%), and none prescribed desiccated thyroid extract. The majority of respondents preferred LT4 tablets. Among alternative formulations, liquid LT4 was most commonly recommended for patients unable to take LT4 in the fasting state (26.0%) and patients with malabsorption (19.9%). Respondents considered prescribing dietary supplements (such as selenium and iodine) in hypothyroid patients with coexisting autoimmune thyroiditis (29.6%) or at the patients' request (32.2%). LT4 + LT3 combination therapy was used by 32.2% when symptoms persisted notwithstanding normal serum TSH concentration. Psychosocial factors, comorbidities, and the burden of chronic disease were considered as the most likely causes of persistent symptoms.
Apart from clinical practice recommendations, other factors influence the thyroid hormone therapy patterns. Moreover, certain areas of clinical practice were identified (the use of thyroid hormones in euthyroid subjects and the use of dietary supplements), which are not in accordance with the current evidence.
过去几年中，有关甲状腺功能减退症管理的新证据不断涌现，这影响了专业机构的建议。甲状腺功能减退症患者的表现也发生了变化，越来越多的新病例通过无差别筛查被诊断出来，而这些病例往往仅存在轻微的生化紊乱。对于这种不断变化的情况，医生的反应和态度知之甚少。THESIS（欧洲专家治疗甲状腺功能减退症：一项国际调查）是一项针对治疗甲状腺功能减退症的欧洲医生的大型调查。在这里，我们记录了波兰医生在甲状腺功能减退症和甲状腺功能正常的患者中使用甲状腺激素的当前做法。
波兰内分泌学会的成员被邀请参与基于网络的 THESIS 调查。
共有 423 名（774 名受邀者中的 54.6%）医生完成了调查。大多数受访者（74.2%）会根据某些适应症为甲状腺功能正常的患者开具甲状腺激素处方，例如甲状腺自身抗体升高的女性不孕（63.4%）、单纯性甲状腺肿（40.9%）、不明原因疲劳（12.1%）、肥胖（9.7%）、高胆固醇血症（9.0%）和抑郁症（9.2%）。几乎所有医生（96.0%）都表示，甲状腺功能减退症的治疗选择是左甲状腺素（LT4）。然而，约三分之一（30.3%）的医生也在使用 LT4 和三碘甲状腺原氨酸（LT3）联合治疗；单独使用 LT3 的情况很少见（1.7%），没有人开干燥甲状腺提取物。大多数受访者更喜欢 LT4 片剂。在替代剂型中，液体 LT4 最常用于不能空腹服用 LT4 的患者（26.0%）和吸收不良的患者（19.9%）。受访者认为在合并自身免疫性甲状腺炎的甲状腺功能减退症患者中（29.6%）或在患者要求下（32.2%）应开具膳食补充剂。当尽管血清 TSH 浓度正常但症状仍持续存在时，32.2%的医生会使用 LT4+LT3 联合治疗。社会心理因素、合并症和慢性病负担被认为是持续症状的最可能原因。
除了临床实践建议外，其他因素也会影响甲状腺激素治疗模式。此外，还确定了某些临床实践领域（甲状腺功能正常患者使用甲状腺激素和使用膳食补充剂），这些领域与当前证据不符。
