Use of thyroid hormones in hypothyroid and euthyroid patients: a THESIS* survey of
Belgian specialists *THESIS: treatment of hypothyroidism in Europe by specialists:
an international survey
Burlacu, Maria-Cristina ✉; Attanasio, Roberto; Hegedus, Laszlo; Nagy, Endre V [Nagy, Endre (Endokrinológia), szerző] Endocrinológiai Tanszék (DE /
ÁOK / BelgyI); Papini, Enrico; Perros, Petros; Sawadogo, Kiswendsida; Bex, Marie; Corvilain, Bernard; Daumerie, Chantal; Decallonne, Brigitte; Gruson, Damien; Lapauw, Bruno; Reyes, Rodrigo Moreno; Petrossians, Patrick; Poppe, Kris; Van den Bruel, Annick; Unuane, David
Background: Hypothyroidism is a topic that continues to provoke debate and controversy
with regards to specific indications, type of thyroid hormone substitution and efficacy.
We investigated the use of thyroid hormones in clinical practice in Belgium, a country
where currently only levothyroxine (LT4) tablet formulations are available.Method:
Members of the Belgian Endocrine Society were invited to respond to an online questionnaire.
Results were compared with those from other THESIS surveys.Results: Eighty (50%) of
the invited 160 individuals, completed the questionnaire. LT4 was the first treatment
of choice for all respondents. As secondary choice, some also prescribed liothyronine
(LT3) and LT4 + LT3 combinations (2 and 7 respondents, respectively). Besides hypothyroidism,
34 and 50% of respondents used thyroid hormones for infertile euthyroid TPOAb positive
women and the treatment of a growing non-toxic goiter, respectively. Had alternative
formulations of LT4 to tablets been available (soft gel or liquid L-T4), 2 out of
80 (2.5%) participants would consider them for patients achieving biochemical euthyroidism
but remaining symptomatic. This proportion was higher in case of unexplained poor
biochemical control of hypothyroidism (13.5%) and in patients with celiac disease
or malabsorption or interfering drugs (10%). In symptomatic euthyroid patients, 20%
of respondents would try combined LT4+ LT3 treatment. Psychosocial factors were highlighted
as the main contributors to persistent symptoms.Conclusions: LT4 tablets is the preferred
treatment for hypothyroidism in Belgium. A minority of the respondents would try combined
LT4+ LT3 in symptomatic but biochemically euthyroid patients. Thyroid hormones are
prescribed for euthyroid infertile women with thyroid autoimmunity and patients with
non-toxic goiter, a tendency noted in other European countries, despite current evidence
of lack of benefit.
