The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform

Francesco S. Celi - One of the best experts on this subject based on the ideXlab platform.

  • evidence based use of levothyroxine Liothyronine combinations in treating hypothyroidism a consensus document
    European thyroid journal, 2021
    Co-Authors: Jacqueline Jonklaas, Francesco S. Celi, Elizabeth A Mcaninch, Antonio C Bianco, Anne R Cappola, Eric Fliers, Heike Heuer, Lars C Moeller, Birte Nygaard, Anna M Sawka
    Abstract:

    Background Fourteen clinical trials have not shown a consistent benefit of combination therapy with levothyroxine (LT4) and Liothyronine (LT3). Despite the publication of these trials, combination therapy is widely used and patients reporting benefit continue to generate patient and physician interest in this area. Recent scientific developments may provide insight into this inconsistency and guide future studies. Methods The American Thyroid Association (ATA), British Thyroid Association (BTA), and European Thyroid Association (ETA) held a joint conference on November 3, 2019 (live-streamed between Chicago and London) to review new basic science and clinical evidence regarding combination therapy with presentations and input from 12 content experts. After the presentations, the material was synthesized and used to develop Summary Statements of the current state of knowledge. After review and revision of the material and Summary Statements, there was agreement that there was equipoise for a new clinical trial of combination therapy. Consensus Statements encapsulating the implications of the material discussed with respect to the design of future clinical trials of LT4/LT3 combination therapy were generated. Authors voted upon the Consensus Statements. Iterative changes were made in several rounds of voting and after comments from ATA/BTA/ETA members. Results Of 34 Consensus Statements available for voting, 28 received at least 75% agreement, with 13 receiving 100% agreement. Those with 100% agreement included studies being powered to study the effect of deiodinase and thyroid hormone transporter polymorphisms on study outcomes, inclusion of patients dissatisfied with their current therapy and requiring at least 1.2 µg/kg of LT4 daily, use of twice daily LT3 or preferably a slow-release preparation if available, use of patient-reported outcomes as a primary outcome (measured by a tool with both relevant content validity and responsiveness) and patient preference as a secondary outcome, and utilization of a randomized placebo-controlled adequately powered double-blinded parallel design. The remaining statements are presented as potential additional considerations. Discussion This article summarizes the areas discussed and presents Consensus Statements to guide development of future clinical trials of LT4/LT3 combination therapy. The results of such redesigned trials are expected to be of benefit to patients and of value to inform future thyroid hormone replacement clinical practice guidelines treatment recommendations.

  • evidence based use of levothyroxine Liothyronine combinations in treating hypothyroidism a consensus document
    Thyroid, 2021
    Co-Authors: Jacqueline Jonklaas, Francesco S. Celi, Elizabeth A Mcaninch, Antonio C Bianco, Anne R Cappola, Eric Fliers, Heike Heuer, Lars C Moeller, Birte Nygaard, Anna M Sawka
    Abstract:

    Background: Fourteen clinical trials have not shown a consistent benefit of combination therapy with levothyroxine (LT4) and Liothyronine (LT3). Despite the publication of these trials, combination...

  • the dynamic pituitary response to escalating dose trh stimulation test in hypothyroid patients treated with Liothyronine or levothyroxine replacement therapy
    The Journal of Clinical Endocrinology and Metabolism, 2013
    Co-Authors: Sahzene Yavuz, Frank Pucino, Xiongce Zhao, Joyce D Linderman, Sheila Smith, Francesco S. Celi
    Abstract:

    Context: A recent trial showed that 1:3 μg:μg Liothyronine (L-T3) substitution for levothyroxine (L-T4) achieving near-identical TSH levels resulted in a significant decrease in weight and cholesterol levels with no appreciable changes in cardiovascular parameters, suggesting a differential peripheral response to the therapy. Objective: We characterized the pituitary-thyroid axis in hypothyroid patients receiving equivalent doses of L-T3 or L-T4 by escalating-dose TRH stimulation test. Design: A secondary analysis of a L-T3 vs L-T4 therapy trial was performed. Setting: The study was conducted at the National Institutes of Health. Patients: Thirteen patients were studied. Interventions: Escalating-dose (5, 15, and 200 μg) TRH stimulation test on both treatment arms. Main Outcome Measures: Study outcomes were peak serum TSH concentration (Cmax), time to peak TSH concentration (Tmax), area under the curve from 0 to 60 minutes (AUC0–60) after TRH injection. Results: Thirteen patients aged 51.2 ± 8.29 years co...

  • metabolic effects of Liothyronine therapy in hypothyroidism a randomized double blind crossover trial of Liothyronine versus levothyroxine
    The Journal of Clinical Endocrinology and Metabolism, 2011
    Co-Authors: Francesco S. Celi, Joyce D Linderman, Sheila Smith, Monica C Skarulis, Marina Zemskova, Bart Drinkard, Vandana Sachdev, Merel Kozlosky, Gyorgy Csako, Rene Costello
    Abstract:

    Context: Levothyroxine (l-T4) therapy is based on the assumption that the conversion of T4 into T3 provides adequate amounts of active hormone at target tissues. However, in rodents, l-T4 alone does not restore a euthyroid state in all tissues. Previous combination l-T4/Liothyronine (l-T3) therapy trials focused on quality-of-life endpoints, and limited information is available on the effects on other measures of thyroid hormone action. Objective: Our objective was to evaluate the efficacy of thyroid hormone replacement with l-T4 or l-T3 at doses producing equivalent normalization of TSH. Participants, Design, and Setting: Fourteen hypothyroid patients participated in this randomized, double-blind, crossover intervention at the National Institutes of Health Clinical Center. Interventions: l-T3 or l-T4 were administered thrice daily to achieve a target TSH from 0.5–1.5 mU/liter. Volunteers were studied as inpatients after 6 wk on a stable dose and at the target TSH. Main Outcome Measures: Serum thyroid hor...

Anne R Cappola - One of the best experts on this subject based on the ideXlab platform.

  • evidence based use of levothyroxine Liothyronine combinations in treating hypothyroidism a consensus document
    European thyroid journal, 2021
    Co-Authors: Jacqueline Jonklaas, Francesco S. Celi, Elizabeth A Mcaninch, Antonio C Bianco, Anne R Cappola, Eric Fliers, Heike Heuer, Lars C Moeller, Birte Nygaard, Anna M Sawka
    Abstract:

    Background Fourteen clinical trials have not shown a consistent benefit of combination therapy with levothyroxine (LT4) and Liothyronine (LT3). Despite the publication of these trials, combination therapy is widely used and patients reporting benefit continue to generate patient and physician interest in this area. Recent scientific developments may provide insight into this inconsistency and guide future studies. Methods The American Thyroid Association (ATA), British Thyroid Association (BTA), and European Thyroid Association (ETA) held a joint conference on November 3, 2019 (live-streamed between Chicago and London) to review new basic science and clinical evidence regarding combination therapy with presentations and input from 12 content experts. After the presentations, the material was synthesized and used to develop Summary Statements of the current state of knowledge. After review and revision of the material and Summary Statements, there was agreement that there was equipoise for a new clinical trial of combination therapy. Consensus Statements encapsulating the implications of the material discussed with respect to the design of future clinical trials of LT4/LT3 combination therapy were generated. Authors voted upon the Consensus Statements. Iterative changes were made in several rounds of voting and after comments from ATA/BTA/ETA members. Results Of 34 Consensus Statements available for voting, 28 received at least 75% agreement, with 13 receiving 100% agreement. Those with 100% agreement included studies being powered to study the effect of deiodinase and thyroid hormone transporter polymorphisms on study outcomes, inclusion of patients dissatisfied with their current therapy and requiring at least 1.2 µg/kg of LT4 daily, use of twice daily LT3 or preferably a slow-release preparation if available, use of patient-reported outcomes as a primary outcome (measured by a tool with both relevant content validity and responsiveness) and patient preference as a secondary outcome, and utilization of a randomized placebo-controlled adequately powered double-blinded parallel design. The remaining statements are presented as potential additional considerations. Discussion This article summarizes the areas discussed and presents Consensus Statements to guide development of future clinical trials of LT4/LT3 combination therapy. The results of such redesigned trials are expected to be of benefit to patients and of value to inform future thyroid hormone replacement clinical practice guidelines treatment recommendations.

  • evidence based use of levothyroxine Liothyronine combinations in treating hypothyroidism a consensus document
    Thyroid, 2021
    Co-Authors: Jacqueline Jonklaas, Francesco S. Celi, Elizabeth A Mcaninch, Antonio C Bianco, Anne R Cappola, Eric Fliers, Heike Heuer, Lars C Moeller, Birte Nygaard, Anna M Sawka
    Abstract:

    Background: Fourteen clinical trials have not shown a consistent benefit of combination therapy with levothyroxine (LT4) and Liothyronine (LT3). Despite the publication of these trials, combination...

  • design of the optimal trial of combination therapy
    Frontiers in Endocrinology, 2020
    Co-Authors: Anne R Cappola
    Abstract:

    Patients who take levothyroxine monotherapy to treat hypothyroidism frequently experience residual symptoms despite TSH testing at target levels. Trials have been conducted to evaluate the potential benefit of combination therapy with levothyroxine and Liothyronine, though results have not consistently demonstrated benefit. In addition to randomization, placebo-control, and masking, four additional design choices to consider include the study population, dosing strategy for levothyroxine and Liothyronine, primary and secondary outcome selection, and statistical power. A thoughtful design that considers these features will increase the likelihood that a combination trial will be considered definitive and finally resolve the important question of whether combination therapy with levothyroxine and Liothyronine is a better thyroid replacement strategy than levothyroxine monotherapy.

Antonio C Bianco - One of the best experts on this subject based on the ideXlab platform.

  • comparative effectiveness of levothyroxine desiccated thyroid extract and levothyroxine Liothyronine in hypothyroidism
    The Journal of Clinical Endocrinology and Metabolism, 2021
    Co-Authors: Tatiana L Fonseca, Elizabeth A Mcaninch, Thanh D Hoang, Vinh Q Mai, Mohamed K M Shakir, Antonio C Bianco, Daniel I Brooks
    Abstract:

    INTRODUCTION Studies comparing levothyroxine (LT4) therapy with LT4 + Liothyronine (LT3) or desiccated thyroid extract (DTE) did not detect consistent superiority of either treatment. Here, we investigated these therapies, focusing on the whole group of LT4-treated hypothyroid patients, while also exploring the most symptomatic patients. METHODOLOGY Prospective, randomized, double-blind, crossover study of 75 hypothyroid patients randomly allocated to 1 of 3 treatment arms, LT4, LT4 + LT3, and DTE, for 22 weeks. The primary outcomes were posttreatment scores on the 36-point thyroid symptom questionnaire (TSQ-36), 12-point quality of life general health questionnaire (GHQ-12), the Wechsler memory scale-version IV (VMS-IV), and the Beck Depression Inventory (BDI). Secondary endpoints included treatment preference, biochemical and metabolic parameters, etiology of hypothyroidism, and Thr92Ala-DIO2 gene polymorphism. Analyses were performed with a linear mixed model using subject as a random factor and group as a fixed effect. RESULTS Serum TSH remained within reference range across all treatment arms. There were no differences for primary and secondary outcomes, except for a minor increase in heart rate caused by DTE. Treatment preference was not different and there were no interferences of the etiology of hypothyroidism or Thr92Ala-DIO2 gene polymorphism in the outcomes. Subgroup analyses of the 1/3 most symptomatic patients on LT4 revealed strong preference for treatment containing T3, which improved performance on TSQ-36, GHQ-12, BDI, and visual memory index (VMS-IV component). CONCLUSIONS As a group, outcomes were similar among hypothyroid patients taking DTE vs LT4 + T3 vs LT4. However, those patients that were most symptomatic on LT4 preferred and responded positively to therapy with LT4 + LT3 or DTE.

  • evidence based use of levothyroxine Liothyronine combinations in treating hypothyroidism a consensus document
    European thyroid journal, 2021
    Co-Authors: Jacqueline Jonklaas, Francesco S. Celi, Elizabeth A Mcaninch, Antonio C Bianco, Anne R Cappola, Eric Fliers, Heike Heuer, Lars C Moeller, Birte Nygaard, Anna M Sawka
    Abstract:

    Background Fourteen clinical trials have not shown a consistent benefit of combination therapy with levothyroxine (LT4) and Liothyronine (LT3). Despite the publication of these trials, combination therapy is widely used and patients reporting benefit continue to generate patient and physician interest in this area. Recent scientific developments may provide insight into this inconsistency and guide future studies. Methods The American Thyroid Association (ATA), British Thyroid Association (BTA), and European Thyroid Association (ETA) held a joint conference on November 3, 2019 (live-streamed between Chicago and London) to review new basic science and clinical evidence regarding combination therapy with presentations and input from 12 content experts. After the presentations, the material was synthesized and used to develop Summary Statements of the current state of knowledge. After review and revision of the material and Summary Statements, there was agreement that there was equipoise for a new clinical trial of combination therapy. Consensus Statements encapsulating the implications of the material discussed with respect to the design of future clinical trials of LT4/LT3 combination therapy were generated. Authors voted upon the Consensus Statements. Iterative changes were made in several rounds of voting and after comments from ATA/BTA/ETA members. Results Of 34 Consensus Statements available for voting, 28 received at least 75% agreement, with 13 receiving 100% agreement. Those with 100% agreement included studies being powered to study the effect of deiodinase and thyroid hormone transporter polymorphisms on study outcomes, inclusion of patients dissatisfied with their current therapy and requiring at least 1.2 µg/kg of LT4 daily, use of twice daily LT3 or preferably a slow-release preparation if available, use of patient-reported outcomes as a primary outcome (measured by a tool with both relevant content validity and responsiveness) and patient preference as a secondary outcome, and utilization of a randomized placebo-controlled adequately powered double-blinded parallel design. The remaining statements are presented as potential additional considerations. Discussion This article summarizes the areas discussed and presents Consensus Statements to guide development of future clinical trials of LT4/LT3 combination therapy. The results of such redesigned trials are expected to be of benefit to patients and of value to inform future thyroid hormone replacement clinical practice guidelines treatment recommendations.

  • evidence based use of levothyroxine Liothyronine combinations in treating hypothyroidism a consensus document
    Thyroid, 2021
    Co-Authors: Jacqueline Jonklaas, Francesco S. Celi, Elizabeth A Mcaninch, Antonio C Bianco, Anne R Cappola, Eric Fliers, Heike Heuer, Lars C Moeller, Birte Nygaard, Anna M Sawka
    Abstract:

    Background: Fourteen clinical trials have not shown a consistent benefit of combination therapy with levothyroxine (LT4) and Liothyronine (LT3). Despite the publication of these trials, combination...

  • Liothyronine and desiccated thyroid extract in the treatment of hypothyroidism
    Thyroid, 2020
    Co-Authors: Thaer Idrees, Scott Bradley Palmer, Rui M B Maciel, Antonio C Bianco
    Abstract:

    Background: The basis for the treatment of hypothyroidism with levothyroxine (LT4) is that humans activate T4 to triiodothyronine (T3). Thus, while normalizing serum thyrotropin (TSH), LT4 doses should also restore the body's reservoir of T3. However, there is evidence that T3 is not fully restored in LT4-treated patients. Summary: For patients who remain symptomatic on LT4 therapy, clinical guidelines recommend, on a trial basis, therapy with LT4+LT3. Reducing the LT4 dose by 25 mcg/day and adding 2.5-7.5 mcg Liothyronine (LT3) once or twice a day is an appropriate starting point. Transient episodes of hypertriiodothyroninemia with these doses of LT4 and LT3 are unlikely to go above the reference range and have not been associated with adverse drug reactions. Trials following almost a 1000 patients for almost 1 year indicate that similar to LT4, therapy with LT4+LT3 can restore euthyroidism while maintaining a normal serum TSH. An observational study of 400 patients with a mean follow-up of ∼9 years did not indicate increased mortality or morbidity risk due to cardiovascular disease, atrial fibrillation, or fractures after adjusting for age when compared with patients taking only LT4. Desiccated thyroid extract (DTE) is a form of combination therapy in which the LT4/LT3 ratio is ∼4:1; the mean daily dose of DTE needed to normalize serum TSH contains ∼11 mcg T3, but some patients may require higher doses. The DTE remains outside formal FDA oversight, and consistency of T4 and T3 contents is monitored by the manufacturers only. Conclusions: Newly diagnosed hypothyroid patients should be treated with LT4. A trial of combination therapy with LT4+LT3 can be considered for those patients who have unambiguously not benefited from LT4.

Anna M Sawka - One of the best experts on this subject based on the ideXlab platform.

  • evidence based use of levothyroxine Liothyronine combinations in treating hypothyroidism a consensus document
    European thyroid journal, 2021
    Co-Authors: Jacqueline Jonklaas, Francesco S. Celi, Elizabeth A Mcaninch, Antonio C Bianco, Anne R Cappola, Eric Fliers, Heike Heuer, Lars C Moeller, Birte Nygaard, Anna M Sawka
    Abstract:

    Background Fourteen clinical trials have not shown a consistent benefit of combination therapy with levothyroxine (LT4) and Liothyronine (LT3). Despite the publication of these trials, combination therapy is widely used and patients reporting benefit continue to generate patient and physician interest in this area. Recent scientific developments may provide insight into this inconsistency and guide future studies. Methods The American Thyroid Association (ATA), British Thyroid Association (BTA), and European Thyroid Association (ETA) held a joint conference on November 3, 2019 (live-streamed between Chicago and London) to review new basic science and clinical evidence regarding combination therapy with presentations and input from 12 content experts. After the presentations, the material was synthesized and used to develop Summary Statements of the current state of knowledge. After review and revision of the material and Summary Statements, there was agreement that there was equipoise for a new clinical trial of combination therapy. Consensus Statements encapsulating the implications of the material discussed with respect to the design of future clinical trials of LT4/LT3 combination therapy were generated. Authors voted upon the Consensus Statements. Iterative changes were made in several rounds of voting and after comments from ATA/BTA/ETA members. Results Of 34 Consensus Statements available for voting, 28 received at least 75% agreement, with 13 receiving 100% agreement. Those with 100% agreement included studies being powered to study the effect of deiodinase and thyroid hormone transporter polymorphisms on study outcomes, inclusion of patients dissatisfied with their current therapy and requiring at least 1.2 µg/kg of LT4 daily, use of twice daily LT3 or preferably a slow-release preparation if available, use of patient-reported outcomes as a primary outcome (measured by a tool with both relevant content validity and responsiveness) and patient preference as a secondary outcome, and utilization of a randomized placebo-controlled adequately powered double-blinded parallel design. The remaining statements are presented as potential additional considerations. Discussion This article summarizes the areas discussed and presents Consensus Statements to guide development of future clinical trials of LT4/LT3 combination therapy. The results of such redesigned trials are expected to be of benefit to patients and of value to inform future thyroid hormone replacement clinical practice guidelines treatment recommendations.

  • evidence based use of levothyroxine Liothyronine combinations in treating hypothyroidism a consensus document
    Thyroid, 2021
    Co-Authors: Jacqueline Jonklaas, Francesco S. Celi, Elizabeth A Mcaninch, Antonio C Bianco, Anne R Cappola, Eric Fliers, Heike Heuer, Lars C Moeller, Birte Nygaard, Anna M Sawka
    Abstract:

    Background: Fourteen clinical trials have not shown a consistent benefit of combination therapy with levothyroxine (LT4) and Liothyronine (LT3). Despite the publication of these trials, combination...

Jacqueline Jonklaas - One of the best experts on this subject based on the ideXlab platform.

  • evidence based use of levothyroxine Liothyronine combinations in treating hypothyroidism a consensus document
    European thyroid journal, 2021
    Co-Authors: Jacqueline Jonklaas, Francesco S. Celi, Elizabeth A Mcaninch, Antonio C Bianco, Anne R Cappola, Eric Fliers, Heike Heuer, Lars C Moeller, Birte Nygaard, Anna M Sawka
    Abstract:

    Background Fourteen clinical trials have not shown a consistent benefit of combination therapy with levothyroxine (LT4) and Liothyronine (LT3). Despite the publication of these trials, combination therapy is widely used and patients reporting benefit continue to generate patient and physician interest in this area. Recent scientific developments may provide insight into this inconsistency and guide future studies. Methods The American Thyroid Association (ATA), British Thyroid Association (BTA), and European Thyroid Association (ETA) held a joint conference on November 3, 2019 (live-streamed between Chicago and London) to review new basic science and clinical evidence regarding combination therapy with presentations and input from 12 content experts. After the presentations, the material was synthesized and used to develop Summary Statements of the current state of knowledge. After review and revision of the material and Summary Statements, there was agreement that there was equipoise for a new clinical trial of combination therapy. Consensus Statements encapsulating the implications of the material discussed with respect to the design of future clinical trials of LT4/LT3 combination therapy were generated. Authors voted upon the Consensus Statements. Iterative changes were made in several rounds of voting and after comments from ATA/BTA/ETA members. Results Of 34 Consensus Statements available for voting, 28 received at least 75% agreement, with 13 receiving 100% agreement. Those with 100% agreement included studies being powered to study the effect of deiodinase and thyroid hormone transporter polymorphisms on study outcomes, inclusion of patients dissatisfied with their current therapy and requiring at least 1.2 µg/kg of LT4 daily, use of twice daily LT3 or preferably a slow-release preparation if available, use of patient-reported outcomes as a primary outcome (measured by a tool with both relevant content validity and responsiveness) and patient preference as a secondary outcome, and utilization of a randomized placebo-controlled adequately powered double-blinded parallel design. The remaining statements are presented as potential additional considerations. Discussion This article summarizes the areas discussed and presents Consensus Statements to guide development of future clinical trials of LT4/LT3 combination therapy. The results of such redesigned trials are expected to be of benefit to patients and of value to inform future thyroid hormone replacement clinical practice guidelines treatment recommendations.

  • evidence based use of levothyroxine Liothyronine combinations in treating hypothyroidism a consensus document
    Thyroid, 2021
    Co-Authors: Jacqueline Jonklaas, Francesco S. Celi, Elizabeth A Mcaninch, Antonio C Bianco, Anne R Cappola, Eric Fliers, Heike Heuer, Lars C Moeller, Birte Nygaard, Anna M Sawka
    Abstract:

    Background: Fourteen clinical trials have not shown a consistent benefit of combination therapy with levothyroxine (LT4) and Liothyronine (LT3). Despite the publication of these trials, combination...

  • Table_1_Short-Term Time Trends in Prescribing Therapy for Hypothyroidism: Results of a Survey of American Thyroid Association Members.DOCX
    2019
    Co-Authors: Jacqueline Jonklaas, Eshetu Tefera, Nawar Shara
    Abstract:

    Objective: Hypothyroid patients frequently request specific therapies from their physicians. Combination therapy is vigorously discussed at professional meetings. We wished to determine if physician prescribing patterns for hypothyroidism changed during 2017 after specific educational events.Methods: A survey addressing treatment of hypothyroidism was emailed to American Thyroid Association (ATA) members on three occasions in 2017. The Spring emails were sent prior to a satellite symposium addressing hypothyroidism, and prior to the annual Endocrine Society and ATA meetings; the December emails were sent after these events. Physicians were presented with thirteen theoretical patients and chose from 6 therapeutic options, including levothyroxine, synthetic combination therapy, thyroid extract, and Liothyronine monotherapy. The patient scenarios successively incorporated factors potentially providing reasons for considering combination therapy. Multivariate repeated measures logistic regression analyses first examined effects of physician characteristics on prescribing the various therapies. Then, analyses also incorporated timing, by comparing prescribing patterns in February, March, and December.Results: In analyses of prescribing levothyroxine monotherapy vs. any T3 therapy, there was a trend of borderline significance (p = 0.053) for T3 therapy to be prescribed more in December compared with February-March combined. When multivariate analyses were performed controlling for time and physician characteristics, choice of therapy was only significantly affected by country of practice (OR 1.7, CI 1.3–2.2). Physician choice of therapies was also examined for the options of continuing (1) levothyroxine, vs. (2) increasing levothyroxine, (3) adding Liothyronine either with or without levothyroxine reduction, or (4) replacing levothyroxine with desiccated thyroid extract or Liothyronine. When multivariate analyses incorporating time and physician characteristics were performed, respondents in December (OR 1.5, CI 1.0–2.3) and those practicing in North America (OR 1.8, CI 1.2–2.6) were more likely to prescribe Liothyronine.Conclusions: This survey shows that although current North American guidelines do not recommend combination therapy, such therapy is being prescribed more over time and is also more commonly prescribed in North America. It is possible our guidelines are failing to incorporate evidence that physicians are considering when prescribing combination therapy. Such evidence could include data about patient preferences, and this needs to be a focus of future studies.

  • Short-Term Time Trends in Prescribing Therapy for Hypothyroidism: Results of a Survey of American Thyroid Association Members
    'Frontiers Media SA', 2019
    Co-Authors: Jacqueline Jonklaas, Eshetu Tefera, Nawar Shara
    Abstract:

    Objective: Hypothyroid patients frequently request specific therapies from their physicians. Combination therapy is vigorously discussed at professional meetings. We wished to determine if physician prescribing patterns for hypothyroidism changed during 2017 after specific educational events.Methods: A survey addressing treatment of hypothyroidism was emailed to American Thyroid Association (ATA) members on three occasions in 2017. The Spring emails were sent prior to a satellite symposium addressing hypothyroidism, and prior to the annual Endocrine Society and ATA meetings; the December emails were sent after these events. Physicians were presented with thirteen theoretical patients and chose from 6 therapeutic options, including levothyroxine, synthetic combination therapy, thyroid extract, and Liothyronine monotherapy. The patient scenarios successively incorporated factors potentially providing reasons for considering combination therapy. Multivariate repeated measures logistic regression analyses first examined effects of physician characteristics on prescribing the various therapies. Then, analyses also incorporated timing, by comparing prescribing patterns in February, March, and December.Results: In analyses of prescribing levothyroxine monotherapy vs. any T3 therapy, there was a trend of borderline significance (p = 0.053) for T3 therapy to be prescribed more in December compared with February-March combined. When multivariate analyses were performed controlling for time and physician characteristics, choice of therapy was only significantly affected by country of practice (OR 1.7, CI 1.3–2.2). Physician choice of therapies was also examined for the options of continuing (1) levothyroxine, vs. (2) increasing levothyroxine, (3) adding Liothyronine either with or without levothyroxine reduction, or (4) replacing levothyroxine with desiccated thyroid extract or Liothyronine. When multivariate analyses incorporating time and physician characteristics were performed, respondents in December (OR 1.5, CI 1.0–2.3) and those practicing in North America (OR 1.8, CI 1.2–2.6) were more likely to prescribe Liothyronine.Conclusions: This survey shows that although current North American guidelines do not recommend combination therapy, such therapy is being prescribed more over time and is also more commonly prescribed in North America. It is possible our guidelines are failing to incorporate evidence that physicians are considering when prescribing combination therapy. Such evidence could include data about patient preferences, and this needs to be a focus of future studies