Treatment Preferences in Patients With Hypothyroidism

Autor(es)

Beltrao, Fabyan Esberard de Lima ; Carvalhal, Giulia ; Beltrao, Daniele Carvalhal de Almeida ; Beltrao, Fabricia Elizabeth de Lima ; Ribeiro, Miriam O. ; Ettleson, Matthew D. ; Ramos, Helton Estrela ; Bianco, Antonio C.

• Tipo de documento: Artigo Científico
• Fonte: JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM; v. N/A, p. 14-pg., 2024-10-10.

Resumo

Context: Levothyroxine (L-T4) monotherapy is the standard of care for the treatment of hypothyroidism. A minority of L-T4-treated patients remain symptomatic and report better outcomes with combination therapy that contains liothyronine (L-T3) or with desiccated thyroid extract (DTE). Objective: This work aimed to assess patient preferences in the treatment of hypothyroidism. Methods: A systematic review, meta-analysis, meta-regression, and network meta-analysis of randomized controlled trials (RCTs) comparing treatments for adults with hypothyroidism (L-T4 vs L-T4 + L-T3 or DTE). Searches were conducted in PubMed, Embase, and Cochrane databases up to April 10, 2024. Data extraction and quality assessment were independently performed by 4 researchers. Results: Eleven RCTs (8 cross-over studies) with a total of 1135 patients were considered. Overall, 24% of patients preferred L-T4 vs 52% who preferred L-T4 + L-T3 or DTE; 24% had no preference. The meta-analysis confirmed the preference for combination therapy over L-T4 monotherapy (relative risk [RR]: 2.20; 95% CI, 1.38-3.52; P = .0009). Excluding 4 studies reduced the high heterogeneity (I-2 = 81%) without affecting the results (RR: 1.97; 95% CI, 1.52-2.54; P < .00001; I-2 = 24%). This preference profile remained when only crossover studies were considered (RR: 2.84; 95% CI, 1.50-5.39; P < .00001). Network meta-analysis confirmed the preference for DTE and L-T3 + L-T4 vs L-T4 alone. Conclusion: Patients with hypothyroidism prefer combination therapy (L-T3 + L-T4 or DTE) over L-T4 monotherapy. The strength of these findings justifies considering patient preferences in the setting of shared decision-making in the treatment of hypothyroidism. (AU)

• Processo FAPESP: 21/12746-3 - Influência do polimorfismo genético da desiodase do tipo D2 (Ala92-D2) nas funções cognitivas
• Beneficiário: Miriam Oliveira Ribeiro
• Modalidade de apoio: Auxílio à Pesquisa - Regular