{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T11:03:36Z","timestamp":1789988616263,"version":"4.0.1"},"reference-count":45,"publisher":"Georg Thieme Verlag KG","issue":"09","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Exp Clin Endocrinol Diabetes"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objective To identify the attitudes of German thyroid specialists towards\n                    the clinical treatment of hypothyroidism using thyroid hormones (TH).<\/jats:p><jats:p>\n          Methods All members of the thyroid section of the German Endocrine Society\n                    (DGE) were e-mailed an invitation to participate in a web-based survey about\n                    substitution with TH.<\/jats:p><jats:p>\n          Results Out of 206 members of the DGE\u2019s thyroid section, 163\n                    (79.1%) responses were received and included in the analysis. Of\n                    responding members, 98.6% used levothyroxine (LT4) as the treatment of\n                    choice, and 45.4% also prescribed combination therapy with liothyronine\n                    (LT4+LT3) in their clinical practice (p&lt;0.001). LT4+LT3\n                    combination was favored in patients with persistent hypothyroidism symptoms\n                    despite biochemical euthyroidism on LT4 treatment (p&lt;0.001). Of all\n                    respondents, 26.4% never indicated TH therapy for euthyroid patients\n                    (p&lt;0.001), while the remainder would consider THs for one or more\n                    indications (62.9% for euthyroid infertile women with high anti-thyroid\n                    antibody levels (p&lt;0.001), 7.1% in patients with severe\n                    hypercholesterolemia, as complementary treatment (p=0.007), and\n                    57.1% in patients with simple goiter (p&lt;0.001)). In conditions\n                    that could interfere with LT4 absorption, most respondents still preferred\n                    tablets and did not expect a significant difference when switching from one LT4\n                    formulation to another.<\/jats:p><jats:p>\n          Conclusion For German thyroid specialists, LT4 is the treatment of choice\n                    for hypothyroidism. Combination therapy with LT4+LT3 was considered for\n                    patients with persistent symptoms. Even in conditions that could affect\n                    bioavailability, German thyroid specialists prefer LT4 tablets rather than other\n                    LT4 formulations, such as liquid or soft-gel capsules. The widespread use of\n                    thyroid hormone for non-hypothyroid conditions is not consistent with current\n                    evidence and needs further study.<\/jats:p>","DOI":"10.1055\/a-1832-0644","type":"journal-article","created":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T22:43:40Z","timestamp":1654037020000},"page":"577-586","source":"Crossref","is-referenced-by-count":25,"title":["A Questionnaire Survey of German Thyroidologists on the Use of\n                    Thyroid Hormones in Hypothyroid and Euthyroid Patients: The THESIS (Treatment of\n                    Hypothyroidism in Europe by Specialists: An International Survey)\n                    Collaborative"],"prefix":"10.1055","volume":"130","author":[{"given":"Irfan","family":"Vardarli","sequence":"additional","affiliation":[{"name":"Department of Medicine I, Klinikum Vest, Knappschaftskrankenhaus\n                    Recklinghausen, Academic Teaching Hospital, Ruhr-University Bochum,\n                    Recklinghausen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Brandenburg","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes, and Metabolism, Clinical\n                    Chemistry \u2013 Division of Laboratory Research; Endocrine Tumor Center at\n                    WTZ\/Comprehensive Cancer Center, University Hospital Essen, University\n                    of Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laszlo","family":"Heged\u00fcs","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Odense University Hospital,\n                    Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Attanasio","sequence":"additional","affiliation":[{"name":"Scientific Committee Associazione Medici Endocrinologi, Milan,\n                    Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"EndreV.","family":"Nagy","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, Faculty of Medicine,\n                    University of Debrecen, Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Papini","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Ospedale Regina\n                    Apostolorum, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petros","family":"Perros","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon\n                    Tyne, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Weidemann","sequence":"additional","affiliation":[{"name":"Department of Medicine I, Klinikum Vest, Knappschaftskrankenhaus\n                    Recklinghausen, Academic Teaching Hospital, Ruhr-University Bochum,\n                    Recklinghausen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Herrmann","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, University Hospital Essen, Essen,\n                    Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dagmar","family":"F\u00fchrer","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes, and Metabolism, Clinical\n                    Chemistry \u2013 Division of Laboratory Research; Endocrine Tumor Center at\n                    WTZ\/Comprehensive Cancer Center, University Hospital Essen, University\n                    of Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,5,31]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1210\/jc.2013-2409","article-title":"The incidence and prevalence of thyroid dysfunction in Europe: A\n                    meta-analysis","volume":"99","author":"A Garmendia Madariaga","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1089\/thy.2020.0515","article-title":"New formulations of levothyroxine in the treatment of hypothyroidism: Trick or\n                    treat?","volume":"31","author":"E V Nagy","year":"2021","journal-title":"Thyroid"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1080\/17425247.2016.1227782","article-title":"Advancements in the treatment of hypothyroidism with L-T4 liquid formulation or\n                    soft gel capsule: An update","volume":"14","author":"P Fallahi","year":"2017","journal-title":"Expert Opin Drug Deliv"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"802","DOI":"10.1089\/thy.2013.0555","article-title":"Increased psychiatric morbidity before and after the diagnosis of\n                    hypothyroidism: A nationwide register study","volume":"24","author":"M Thvilum","year":"2014","journal-title":"Thyroid"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e75789","DOI":"10.1371\/journal.pone.0075789","article-title":"Type and extent of somatic morbidity before and after the diagnosis of\n                    hypothyroidism. A nationwide register study","volume":"8","author":"M Thvilum","year":"2013","journal-title":"PLoS One"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1069","DOI":"10.1210\/jc.2012-3375","article-title":"Excess mortality in patients diagnosed with hypothyroidism: A nationwide cohort\n                    study of singletons and twins","volume":"98","author":"M Thvilum","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1007\/s12020-019-01946-5","article-title":"Death by unnatural causes, mainly suicide, is increased in patients with\n                    Hashimoto\u2019s thyroiditis. 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risks: Evidence from a large community-based\n                    study","volume":"174","author":"P N Taylor","year":"2014","journal-title":"JAMA Intern Med"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1159\/000437262","article-title":"Treating Hypothyroidism with thyroxine\/triiodothyronine combination\n                    therapy in Denmark: Following guidelines or following trends?","volume":"4","author":"L F Michaelsson","year":"2015","journal-title":"Eur Thyroid J"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"3122","DOI":"10.1210\/jc.2007-0732","article-title":"An increased incidence of overt hypothyroidism after iodine fortification of\n                    salt in Denmark: A prospective population study","volume":"92","author":"I B Pedersen","year":"2007","journal-title":"J Clin Endocrinol Metab"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"910","DOI":"10.1089\/thy.2018.0539","article-title":"Changes in prescription routines for treating hypothyroidism between 2001 and\n                    2015: An observational study of 929,684 primary care patients in Copenhagen","volume":"29","author":"B B Medici","year":"2019","journal-title":"Thyroid"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1089\/thy.2017.0681","article-title":"An online survey of hypothyroid patients demonstrates prominent\n                    dissatisfaction","volume":"28","author":"S J Peterson","year":"2018","journal-title":"Thyroid"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1111\/cen.14340","article-title":"Patient satisfaction and quality of life in hypothyroidism: An online survey by\n                    the British Thyroid Foundation","volume":"94","author":"A L Mitchell","year":"2021","journal-title":"Clin Endocrinol (Oxf)"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"898","DOI":"10.1002\/jbmr.2416","article-title":"The excess risk of major osteoporotic fractures in hypothyroidism is driven by\n                    cumulative hyperthyroid as opposed to hypothyroid time: An observational\n                    register-based time-resolved cohort analysis","volume":"30","author":"B Abrahamsen","year":"2015","journal-title":"J Bone Miner Res"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1530\/EJE-19-0006","article-title":"Duration of over- and under-treatment of hypothyroidism is associated with\n                    increased cardiovascular risk","volume":"180","author":"M Lillevang-Johansen","year":"2019","journal-title":"Eur J Endocrinol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1089\/thy.2017.0517","article-title":"Over- and under-treatment of hypothyroidism is associated with excess mortality:\n                    A register-based cohort study","volume":"28","author":"M Lillevang-Johansen","year":"2018","journal-title":"Thyroid"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1346","DOI":"10.1089\/thy.2019.0353","article-title":"Standardized map of iodine status in Europe","volume":"30","author":"T Ittermann","year":"2020","journal-title":"Thyroid"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1007\/s00103-013-1700-y","article-title":"Gesundheitsbezogene lebensqualit\u00e4t bei erwachsenen in Deutschland -\n                    Ergebnisse einer studie zur gesundheit erwachsener in Deutschland (DEGS1)","volume":"56","author":"U Ellerth","year":"2013","journal-title":"Bundesgesundheitsblatt"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"827","DOI":"10.3238\/arztebl.2010.0827","article-title":"Hormone replacement after thyroid and parathyroid surgery","volume":"107","author":"A Schaffler","year":"2010","journal-title":"Dtsch Arztebl Int"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.ando.2021.11.002","article-title":"Real-life practice of thyroid hormone use in hypothyroid and euthyroid patients:\n                    A detailed view from the THESIS* questionnaire survey in France","author":"C Buffet","year":"2021","journal-title":"Ann Endocrinol (Paris)"},{"key":"ref29","first-page":"299","article-title":"Use of thyroid hormones in hypothyroid and euthyroid patients: A THESIS*\n                    questionnaire survey of Bulgarian physicians *THESIS: Treatment of\n                    Hypthyroidism in Europe by Specialists: An international survey","volume":"XXV","author":"A M Borissova","year":"2020","journal-title":"Endocrinologia"},{"key":"ref30","first-page":"2885","article-title":"Use of thyroid hormones in the treatment of hypothyroidism: Thesis questionnaire\n                    survey for Finnish specialists","volume":"48","author":"S Metso","year":"2021","journal-title":"L\u00e4\u00e4k\u00e4rilehti"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"795111","DOI":"10.3389\/fendo.2021.795111","article-title":"Use of thyroid hormones in hypothyroid and euthyroid patients: A 2020 THESIS\n                    questionnaire survey of members of the Swedish Endocrine Society","volume":"12","author":"T Planck","year":"2021","journal-title":"Front Endocrinol (Lausanne)"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"357","DOI":"10.5603\/EP.a2021.0048","article-title":"Use of thyroid hormones in hypothyroid and euthyroid patients: A THESIS*\n                    questionnaire survey of Polish physicians. *THESIS: Treatment of\n                    hypothyroidism in Europe by specialists: An international survey","volume":"72","author":"T Bednarczuk","year":"2021","journal-title":"Endokrynol Pol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"462","DOI":"10.4183\/aeb.2020.462","article-title":"Use of thyroid hormones in hypothyroid and euthyroid patients: A Thesis*\n                    Questionnaire Survey of Romanian Physicians *Thesis: Treatment of\n                    Hypothyroidism in Europe by Specialists: An international survey","volume":"16","author":"D A Niculescu","year":"2020","journal-title":"Acta Endocrinol (Buchar)"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"2435","DOI":"10.1007\/s40618-021-01555-y","article-title":"Use of thyroid hormones in hypothyroid and euthyroid patients: A 2020 THESIS\n                    questionnaire survey of members of the Danish Endocrine Society","volume":"44","author":"K R Riis","year":"2021","journal-title":"J Endocrinol Invest"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1670","DOI":"10.1089\/thy.2014.0028","article-title":"Guidelines for the treatment of hypothyroidism: Prepared by the American Thyroid\n                    Association Task Force on thyroid hormone replacement","volume":"24","author":"J Jonklaas","year":"2014","journal-title":"Thyroid"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1016\/j.endinu.2021.07.003","article-title":"Use of thyroid hormone in hypothyroid patients and euthyroid subjects in Spain:\n                    A THESIS* questionnaire survey","author":"J C Galofre","year":"2021","journal-title":"Endocrinol Diabetes Nutr (Engl Ed)"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1530\/EJE-12-0105","article-title":"Scoring system for predicting recurrences in patients with papillary thyroid\n                    microcarcinoma","volume":"167","author":"C Buffet","year":"2012","journal-title":"Eur J Endocrinol"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1306","DOI":"10.1016\/j.fertnstert.2020.06.034","article-title":"Effect of levothyroxine on pregnancy outcomes in women with thyroid\n                    autoimmunity: A systematic review with meta-analysis of randomized controlled\n                    trials","volume":"114","author":"X Wang","year":"2020","journal-title":"Fertil Steril"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1316","DOI":"10.1056\/NEJMoa1812537","article-title":"Levothyroxine in women with thyroid peroxidase antibodies before conception","volume":"380","author":"R K Dhillon-Smith","year":"2019","journal-title":"N Engl J Med"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1159\/000512790","article-title":"2021 European Thyroid Association Guideline on thyroid disorders prior to and\n                    during assisted reproduction","volume":"9","author":"K Poppe","year":"2021","journal-title":"Eur Thyroid J"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"622","DOI":"10.4158\/EP161208.GL","article-title":"American Association of Clinical Endocrinologists, American College of\n                    Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for\n                    clinical practice for the diagnosis and management of thyroid nodules \u2013\n                    2016 Update","volume":"22","author":"H Gharib","year":"2016","journal-title":"Endocr Pract"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1536","DOI":"10.1089\/thy.2019.0383","article-title":"Patient requests for tests and treatments impact physician management of\n                    hypothyroidism","volume":"29","author":"N H Esfandiari","year":"2019","journal-title":"Thyroid"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"1982","DOI":"10.1210\/jc.2012-4107","article-title":"Desiccated thyroid extract compared with levothyroxine in the treatment of\n                    hypothyroidism: A randomized, double-blind, crossover study","volume":"98","author":"T D Hoang","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1038\/s41574-019-0311-6","article-title":"Selenium in thyroid disorders \u2013 essential knowledge for clinicians","volume":"16","author":"K H Winther","year":"2020","journal-title":"Nat Rev Endocrinol"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1681","DOI":"10.1089\/thy.2016.0256","article-title":"Selenium supplementation significantly reduces thyroid autoantibody levels in\n                    patients with chronic autoimmune thyroiditis: A systematic review and\n                    meta-analysis","volume":"26","author":"J Wichman","year":"2016","journal-title":"Thyroid"}],"container-title":["Experimental and Clinical Endocrinology &amp; Diabetes"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1832-0644.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,16]],"date-time":"2022-09-16T23:09:24Z","timestamp":1663369764000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1832-0644"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,31]]},"references-count":45,"journal-issue":{"issue":"09","published-online":{"date-parts":[[2022,9,16]]},"published-print":{"date-parts":[[2022,9]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1832-0644","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0947-7349","1439-3646"],"issn-type":[{"value":"0947-7349","type":"print"},{"value":"1439-3646","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,31]]}}}