Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients: a THESIS* Questionnaire Survey of Bulgarian Physicians

Author: Borissova, Anna-Maria I.1, Boyanov, Mihail A.2, Attanasio, Roberto3, Hegedüs, Laszlo4, Nagy, Endre5, Negro, Roberto6, Papini, Enrico7, Perros, Petros8

1 Клиника по Ендокринология и болести на обмяната, УМБАЛ “Софиямед”, Медицински факултет, Софийски университет “Свети Климент Охридски”, София, България
2 Клиника по Ендокринология и болести на обмяната, УМБАЛ “Александровска”; Катедра Вътрешни болести, Медицински университет, София, България
3 Endocrine Unit, Galeazzi Orthopedic Institute IRCCS, 20161 Milan, Italy
4 Department of Endocrinology and Metabolism, Odense University Hospital, University of Southern Denmark, Odense, Denmark
5 Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
6 Division of Endocrinology, V. Fazzi Hospital, Lecce, Italy
7 Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano, Rome, Italy
8 Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom


Aim of the study: to describe the use of thyroid hormones in hypothyroid and euthyroid patients by Bulgarian physicians with a focus on the formulations of levothyroxine (LT4).

Materials and Methods: This is a cross-sectional, questionnaire-based survey. 120 physicians participated (88 females /32 males); 62,4% aged over 50 years. 74% were specialists in endocrinology, the remaining – general practitioners, internal medicine specialists, and a few others. The original questionnaire from the THESIS survey was used in Bulgarian. Its first part contained 8 questions exploring the physicians’ characteristics (sex, age, specialty, years in medical practice, and others). The second part contained 24 questions revealing the preferences in the treatment of hypothyroidism. The statistical analysis was performed on the IBM SPSS 19.0 for Windows statistical package.

Results: One third (33,3%) of the participating physicians would not recommend LT4 to euthyroid patients. 96% of the respondents accepted and 100% prescribed LT4 as first line replacement therapy in hypothyroidism. Very few respondents (10%) found a place for prescribing triiodothyronine (LT3) or a combination of LТ3 + LТ4 (6%). The LT4 tablets were the preferred formulation by more than half of the respondents, however one fifth would prescribe soft-gel capsules also, and one sixth – the liquid solution. 52,5% of the physicians would not administer iodine or selenium; 34,2% would recommend LТ4 + LТ3 for shorter periods in prolonged hypothyroidism; and 24,2% – in case of persisting hypothyroid symptoms despite a normal TSH. The persistent symptoms despite optimal hormonal control were attributed to comorbidities, psychosocial factors, the chronic fatigue syndrome and the unrealistic patients’ expectations. 16 respondents (13,3%) admitted to have hypothyroidism and 43,8% of them reported excessive tiredness/fatigue. 25% of them would try LT4 + LT3 , or desiccated thyroid extract (25%).

Conclusion: LT4 is the primary thyroid hormone used in our country. The LT4+LT3 treatment and desiccated thyroid might still find use in the practice of some physicians. This study highlighted the difference between the treatment guidelines and consensuses, and real life.

Key words: hypothyroidism, levothyroxine, clinical practice, questionnaire

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