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Published on: February 9, 2024
552
Treatment Preferences in Patients With Hypothyroidism
Fabyan Esberard de Lima Beltrão1,2, Giulia Carvalhal3, Daniele Carvalhal de Almeida Beltrão2,4
1Lauro Wanderley University Hospital, Department of Internal Medicine, Federal University of Paraíba, João Pessoa, Paraíba 58050-585, Brazil.
The Journal of Clinical Endocrinology and Metabolism
|September 18, 2024
Summary
Patients with hypothyroidism often prefer combination therapy, including liothyronine (L-T3) or desiccated thyroid extract (DTE), over levothyroxine (L-T4) monotherapy. This preference highlights the importance of individualized treatment decisions for hypothyroidism.
Area of Science:
- Endocrinology
- Pharmacology
- Clinical Medicine
Background:
- Levothyroxine (L-T4) is the standard treatment for hypothyroidism.
- Some patients remain symptomatic on L-T4 monotherapy, reporting benefits from combination therapy with liothyronine (L-T3) or desiccated thyroid extract (DTE).
Purpose of the Study:
- To evaluate patient preferences for different hypothyroidism treatment regimens.
- To compare patient-reported outcomes between L-T4 monotherapy and combination therapies (L-T4 + L-T3 or DTE).
Main Methods:
- Systematic review, meta-analysis, meta-regression, and network meta-analysis of randomized controlled trials (RCTs).
- Searches included PubMed, Embase, and Cochrane databases up to April 10, 2024.
- Data extraction and quality assessment were performed by four independent researchers.
Main Results:
- Eleven RCTs involving 1135 patients were analyzed.
- 52% of patients preferred combination therapy (L-T4 + L-T3 or DTE) compared to 24% preferring L-T4 monotherapy.
- Meta-analysis confirmed a significant preference for combination therapy (RR: 2.20; P = .0009), with reduced heterogeneity after excluding four studies (RR: 1.97; P < .00001).
Conclusions:
- Patients with hypothyroidism demonstrate a clear preference for combination therapy over L-T4 monotherapy.
- These findings support the inclusion of patient preferences in shared decision-making for hypothyroidism treatment.
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