TY - JOUR
T1 - Use of thyroid hormones in euthyroid patients with unexplained fatigue
T2 - analyses of aggregate data from European national surveys of professional endocrine society members
AU - Bednarczuk, Tomasz
AU - Sugier, Aleksandra
AU - Attanasio, Roberto
AU - Nagy, Endre V.
AU - Negro, Roberto
AU - Papini, Enrico
AU - Žarković, Miloš
AU - Akarsu, Ersin
AU - Alevizaki, Maria
AU - Ayvaz, Göksun
AU - Nedeljković Beleslin, Biljana
AU - Berta, Eszter
AU - Bodor, Miklos
AU - Borissova, Anna M.
AU - Boyanov, Mihail
AU - Buffet, Camille
AU - Burlacu, Maria Cristina
AU - Cohen, Chagit A.
AU - Ćirić, Jasmina
AU - Díez, Juan J.
AU - Dobnig, Harald
AU - Fadeyev, Valentin
AU - Field, Benjamin C.T.
AU - Fliers, Eric
AU - Führer-Sakel, Dagmar
AU - Frølich, Jacob S.
AU - Galofré, Juan C.
AU - Hakala, Tommi
AU - Jiskra, Jan
AU - Kopp, Peter A.
AU - Krebs, Michael
AU - Kršek, Michal
AU - Kužma, Martin
AU - Lazúrová, Ivica
AU - Leenhardt, Laurence
AU - Ludgate, Stephen
AU - Luchytskiy, Vitaliy
AU - McGowan, Anne
AU - Melo, Miguel
AU - Metso, Saara
AU - Moran, Carla
AU - Morgunova, Tatyana
AU - Niculescu, Dan A.
AU - Perić, Božidar
AU - Planck, Tereza
AU - Poiana, Catalina
AU - Puga, Francisca M.
AU - Robenshtok, Eyal
AU - Rosselet, Patrick
AU - Ruchala, Marek
AU - Riis, Kamilla R.
AU - Shepelkevich, Alla
AU - Tronko, Mykola D.
AU - Unuane, David
AU - Vardarli, Irfan
AU - Visser, W. Edward
AU - Vryonidou, Andromachi
AU - Younes, Younes Ramazan
AU - Yurenya, Elena
AU - Perros, Petros
AU - Hegedüs, Laszlo
N1 - Publisher Copyright:
Copyright © 2025 Bednarczuk, Sugier, Attanasio, Nagy, Negro, Papini, Žarković, Akarsu, Alevizaki, Ayvaz, Nedeljković Beleslin, Berta, Bodor, Borissova, Boyanov, Buffet, Burlacu, Cohen, Ćirić, Díez, Dobnig, Fadeyev, Field, Fliers, Führer-Sakel, Frølich, Galofré, Hakala, Jiskra, Kopp, Krebs, Kršek, Kužma, Lazúrová, Leenhardt, Ludgate, Luchytskiy, McGowan, Melo, Metso, Moran, Morgunova, Niculescu, Perić, Planck, Poiana, Puga, Robenshtok, Rosselet, Ruchala, Riis, Shepelkevich, Tronko, Unuane, Vardarli, Visser, Vryonidou, Younes, Yurenya, Perros and Hegedüs.
PY - 2025
Y1 - 2025
N2 - Background: Managing patients with fatigue is a clinical challenge. Because fatigue is often reported in hypothyroidism, thyroid hormone (TH) therapy may sometimes be incorrectly considered for biochemically euthyroid individuals. This study aimed to evaluate the prevalence and determinants of this practice in different European countries. Methods: We analyzed aggregate data from the THESIS (Treatment of Hypothyroidism in Europe by Specialists: an International Survey) online survey. We analyzed responses from 5,695 members of 28 national endocrine/thyroid societies’ specialists to the statement: “Thyroid hormones may be indicated in biochemically euthyroid patients with unexplained fatigue”. Results: Overall, 7.5% (426/5695) of respondents indicated that TH therapy might be considered for euthyroid patients with unexplained fatigue. The proportion of positive responses varied widely across different countries (between 1.1% in Switzerland and 29.3% in Serbia; p=2 ×10-16) and regions (between 4.7% in Western Europe and 8.7% in Western Asia or 8.8% in Eastern Europe; p=0.004). TH were more frequently prescribed for unexplained fatigue by male respondents (Odds Ratio, OR 1.45, 95% CI 1.18-1.78) and physicians practicing in private practice (OR 1.27, 95% CI 1.02-1.58), and less frequently by endocrinologists (OR 0.62, 95% CI 0.46-0.83). Conclusion: A small, yet not negligible percentage of European thyroid-focused physicians consider using TH for euthyroid patients with unexplained fatigue, with significant variations based on geographic, demographic, and practice-related factors. Using levothyroxine and/or liothyronine in such cases lacks evidence and may partially contribute to the concerning overuse of TH therapy.
AB - Background: Managing patients with fatigue is a clinical challenge. Because fatigue is often reported in hypothyroidism, thyroid hormone (TH) therapy may sometimes be incorrectly considered for biochemically euthyroid individuals. This study aimed to evaluate the prevalence and determinants of this practice in different European countries. Methods: We analyzed aggregate data from the THESIS (Treatment of Hypothyroidism in Europe by Specialists: an International Survey) online survey. We analyzed responses from 5,695 members of 28 national endocrine/thyroid societies’ specialists to the statement: “Thyroid hormones may be indicated in biochemically euthyroid patients with unexplained fatigue”. Results: Overall, 7.5% (426/5695) of respondents indicated that TH therapy might be considered for euthyroid patients with unexplained fatigue. The proportion of positive responses varied widely across different countries (between 1.1% in Switzerland and 29.3% in Serbia; p=2 ×10-16) and regions (between 4.7% in Western Europe and 8.7% in Western Asia or 8.8% in Eastern Europe; p=0.004). TH were more frequently prescribed for unexplained fatigue by male respondents (Odds Ratio, OR 1.45, 95% CI 1.18-1.78) and physicians practicing in private practice (OR 1.27, 95% CI 1.02-1.58), and less frequently by endocrinologists (OR 0.62, 95% CI 0.46-0.83). Conclusion: A small, yet not negligible percentage of European thyroid-focused physicians consider using TH for euthyroid patients with unexplained fatigue, with significant variations based on geographic, demographic, and practice-related factors. Using levothyroxine and/or liothyronine in such cases lacks evidence and may partially contribute to the concerning overuse of TH therapy.
KW - euthyroidism
KW - fatigue
KW - levothyroxine
KW - survey
KW - thyroid hormone
U2 - 10.3389/fendo.2025.1713814
DO - 10.3389/fendo.2025.1713814
M3 - Article
AN - SCOPUS:105022628672
SN - 1664-2392
VL - 16
JO - Frontiers in Endocrinology
JF - Frontiers in Endocrinology
M1 - 1713814
ER -
SDG 3 – Hyvä terveys ja hyvinvointi