de Lima Beltrão Fabyan Esberard, Carvalhal Giulia, de Almeida Beltrão Daniele Carvalhal, de Lima Beltrão Fabricia Elizabeth, Ribeiro Miriam O, Ettleson Matthew D, Ramos Helton Estrela, Bianco Antonio C
Lauro Wanderley University Hospital, Department of Internal Medicine, Federal University of Paraíba, João Pessoa, Paraíba 58050-585, Brazil.
Department of Internal Medicine, University Centre of João Pessoa (UNIPE), João Pessoa, Paraíba 58053-000, Brazil.
J Clin Endocrinol Metab. 2025 Feb 18;110(3):887-900. doi: 10.1210/clinem/dgae651.
Levothyroxine (L-T4) monotherapy is the standard of care for the treatment of hypothyroidism. A minority of L-T4-treated patients remain symptomatic and report better outcomes with combination therapy that contains liothyronine (L-T3) or with desiccated thyroid extract (DTE).
This work aimed to assess patient preferences in the treatment of hypothyroidism.
A systematic review, meta-analysis, meta-regression, and network meta-analysis of randomized controlled trials (RCTs) comparing treatments for adults with hypothyroidism (L-T4 vs L-T4 + L-T3 or DTE). Searches were conducted in PubMed, Embase, and Cochrane databases up to April 10, 2024. Data extraction and quality assessment were independently performed by 4 researchers.
Eleven RCTs (8 cross-over studies) with a total of 1135 patients were considered. Overall, 24% of patients preferred L-T4 vs 52% who preferred L-T4 + L-T3 or DTE; 24% had no preference. The meta-analysis confirmed the preference for combination therapy over L-T4 monotherapy (relative risk [RR]: 2.20; 95% CI, 1.38-3.52; P = .0009). Excluding 4 studies reduced the high heterogeneity (I2 = 81%) without affecting the results (RR: 1.97; 95% CI, 1.52-2.54; P < .00001; I2 = 24%). This preference profile remained when only crossover studies were considered (RR: 2.84; 95% CI, 1.50-5.39; P < .00001). Network meta-analysis confirmed the preference for DTE and L-T3 + L-T4 vs L-T4 alone.
Patients with hypothyroidism prefer combination therapy (L-T3 + L-T4 or DTE) over L-T4 monotherapy. The strength of these findings justifies considering patient preferences in the setting of shared decision-making in the treatment of hypothyroidism.
左甲状腺素（L-T4）单药治疗是甲状腺功能减退症治疗的标准方法。少数接受L-T4治疗的患者仍有症状，且报告称含三碘甲状腺原氨酸（L-T3）的联合治疗或干燥甲状腺提取物（DTE）能带来更好的治疗效果。
本研究旨在评估甲状腺功能减退症治疗中患者的偏好。
对比较成人甲状腺功能减退症治疗方法（L-T4与L-T4 + L-T3或DTE）的随机对照试验（RCT）进行系统评价、荟萃分析、荟萃回归和网状荟萃分析。截至2024年4月10日，在PubMed、Embase和Cochrane数据库中进行检索。由4名研究人员独立进行数据提取和质量评估。
共纳入11项RCT（8项交叉研究），总计1135例患者。总体而言，24%的患者更喜欢L-T4，而52%的患者更喜欢L-T4 + L-T3或DTE；24%的患者无偏好。荟萃分析证实，与L-T4单药治疗相比，患者更倾向于联合治疗（相对风险[RR]：2.20；95%置信区间[CI]，1.38 - 3.52；P = 0.0009）。排除4项研究可降低高异质性（I² = 81%），且不影响结果（RR：1.97；95% CI，1.52 - 2.54；P < 0.00001；I² = 24%）。仅考虑交叉研究时，这种偏好情况依然存在（RR：2.84；95% CI，1.50 - 5.39；P < 0.00001）。网状荟萃分析证实，与单独使用L-T4相比，患者更喜欢DTE以及L-T3 + L-T4。
甲状腺功能减退症患者更喜欢联合治疗（L-T3 + L-T4或DTE）而非L-T4单药治疗。这些研究结果的力度证明，在甲状腺功能减退症治疗的共同决策过程中，应考虑患者的偏好。
