EMPATHY: A New Tool for Identifying the Most Suitable Thyroxine Formulation in Hypothyroid Patients

Area of Science:

• Endocrinology
• Clinical Pharmacology

Background:

• Levothyroxine (LT4) therapy is standard for hypothyroidism, but achieving target thyrotropin (TSH) levels can be challenging.
• Poor compliance (60%) and malabsorption (40%) are primary reasons for treatment failure.
• Currently, no tools exist to pre-emptively detect malabsorption before initiating therapy.

Purpose of the Study:

• To validate the Evaluation of Malabsorption in PATients with HYpothyroidism (EMPATHY) questionnaire.
• To assess the questionnaire's utility in guiding appropriate LT4 therapy selection.

Main Methods:

• The EMPATHY questionnaire, assessing intolerances and allergies, was administered to 150 newly diagnosed hypothyroid patients (group 1).
• A control group (150 patients) received standard care based on history.
• Thyroid hormones and TSH were monitored for six months, with dose adjustments recorded.

Main Results:

• Fewer patients in the EMPATHY group (14%) required more than two dose adjustments compared to the control group (28%).
• Hypothyroidism control (TSH < 2.5 mIU/L) was achieved in more patients using EMPATHY (96%) versus the control group (89%).
• The final LT4 dose was significantly lower in the EMPATHY group (136 ± 28 μg/day) than in the control group (148 ± 33 μg/day).

Conclusions:

• The validated EMPATHY questionnaire is a valuable clinical tool for endocrinologists.
• It facilitates personalized LT4 replacement therapy and accelerates TSH level normalization.
• The questionnaire reduces the need for post-initiation therapy dose adjustments.