Background Replacement of thyroid hormones (TH) with Levothyroxine (LT4) is the treatment
of choice for hypothyroidism, however, there are aspects of treatment where uncertainties
exist and practice varies. Factors influencing initiation and choice of TH replacement
may impact patient satisfaction, safety, and health care costs. Methods The aim of
the study was to examine the attitudes of Irish endocrinologists regarding the treatment
of hypothyroid and euthyroid patients with TH. Members of the Irish Endocrine Society
(IES) were invited to participate in an online survey. Results Forty-eight invitations
were sent, and 39 (81.3%) participants responded. All respondents favoured LT4 tablet
therapy for treatment of hypothyroidism, but 20.5% prescribed combination therapy
(LT4 and liothyronine), and 13% regularly used desiccated thyroid extract. A significant
proportion (51%) might prescribe TH in euthyroid patients; 41% for thyroid auto-antibody
positive women seeking pregnancy, 18% for goitre and 5% for unexplained fatigue. Many
(38%) consider combination therapy in patients with persistent symptoms. Respondents
reported seeing LT4 treated patients with persistent symptomatology more frequently
and perceive psychosocial factors and comorbidities to be the most common reasons
for such symptoms. Conclusion LT4 tablets are the treatment of choice for hypothyroidism
in Ireland. Approximately a third of Irish endocrinologists either regularly use,
or would consider, liothyronine for hypothyroid patients. A significant proportion
would give TH to euthyroid individuals in specific circumstances. The prescription
of TH amongst Irish endocrinologists was generally in keeping with recommended practice,
and areas where practice deviated from guidance were typically where evidence was
conflicting or insufficient.
