Department of Endocrinology, East Surrey Hospital, Surrey & Sussex Healthcare NHS Trust, Redhill, Surrey, UK.
Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Clin Endocrinol (Oxf). 2023 Feb;98(2):238-248. doi: 10.1111/cen.14812. Epub 2022 Sep 16.
Management of hypothyroidism is controversial because of medication cost pressures and scientific uncertainty on how to address treatment dissatisfaction experienced by some patients. The objective was to investigate the experience and preferences of UK endocrinologists in use of thyroid hormones.
Web-based survey.
UK endocrinologists were invited to participate.
Responses to questionnaire.
The response rate was 21% (272/1295). While levothyroxine monotherapy is regarded as the treatment of choice for hypothyroidism, 51% of respondents stated that combined treatment with levothyroxine and liothyronine could be considered for levothyroxine-treated patients whose symptoms persist despite normalisation of serum thyroid stimulating hormone (TSH) concentration. However, only 40% are currently prescribing such treatment, and just 23% would consider taking it themselves. A small minority prescribe desiccated thyroid extract, and those most likely to do so are aged over 60 years. Most respondents stated that they have no influence over brand or formulation of levothyroxine dispensed to their patients and expect no major differences in efficacy between different formulations. A total of 9% would prescribe levothyroxine for euthyroid enlarging goitre, and 29% for euthyroid female infertility with high titre thyroid peroxidase antibodies, despite recent trials finding no benefit.
UK endocrine practice in management of hypothyroidism is broadly in line with international guidance. However, a minority of respondents would consider thyroid hormone supplementation in euthyroid individuals for female infertility, enlarging goitre, and other indications in which evidence of efficacy is lacking. Willingness to consider prescribing combined levothyroxine and liothyronine, for hypothyroid symptoms which persist despite normalised TSH, has increased in comparison to previous international surveys, despite inconsistent evidence of benefit.
由于药物成本压力以及如何解决部分患者治疗不满的科学不确定性，甲状腺功能减退症的治疗存在争议。本研究旨在调查英国内分泌学家在使用甲状腺激素方面的经验和偏好。
基于网络的调查。
邀请英国内分泌学家参与。
问卷调查的回复。
应答率为 21%（272/1295）。左旋甲状腺素单药治疗被认为是甲状腺功能减退症的治疗选择，尽管血清促甲状腺激素（TSH）浓度正常，但 51%的受访者表示，对于接受左旋甲状腺素治疗但症状持续存在的患者，可以考虑联合使用左旋甲状腺素和三碘甲状腺原氨酸。然而，目前只有 40%的医生开具这种治疗方案，只有 23%的医生会考虑自己使用。少数医生会开甲状腺干粉提取物，最有可能这样做的是年龄在 60 岁以上的医生。大多数受访者表示，他们对患者使用的左旋甲状腺素的品牌或剂型没有影响，并且期望不同剂型之间的疗效没有重大差异。共有 9%的受访者会为甲状腺功能正常的甲状腺肿开具左旋甲状腺素，29%的受访者会为甲状腺过氧化物酶抗体滴度高的甲状腺功能正常的女性不孕开具左旋甲状腺素，尽管最近的试验没有发现这种治疗方法有益。
英国内分泌学会在甲状腺功能减退症的管理方面的做法与国际指南基本一致。然而，少数受访者会考虑在甲状腺功能正常的个体中补充甲状腺激素，用于女性不孕、甲状腺肿增大和其他缺乏疗效证据的情况下。与之前的国际调查相比，愿意考虑为甲状腺功能正常但 TSH 正常的患者开具联合左旋甲状腺素和三碘甲状腺原氨酸的处方有所增加，尽管其获益证据并不一致。
