Treatment Preferences in Patients With Hypothyroidism
Tipo
Artigo
Data de publicação
2025
Periódico
Journal of Clinical Endocrinology and Metabolism
Citações (Scopus)
1
Autores
De Lima Beltrao F.E.
Carvalhal G.
De Almeida Beltrao D.C.
De Lima Beltrao F.E.
Ribeiro M.O.
Ettleson M.D.
Ramos H.E.
Bianco A.C.
Carvalhal G.
De Almeida Beltrao D.C.
De Lima Beltrao F.E.
Ribeiro M.O.
Ettleson M.D.
Ramos H.E.
Bianco A.C.
Orientador
Título da Revista
ISSN da Revista
Título de Volume
Membros da banca
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Resumo
© 2024 The Author(s). Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved.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 (I2 = 81%) without affecting the results (RR: 1.97; 95% CI, 1.52-2.54; P <. 00001; I2 = 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.
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Assuntos Scopus
Drug Therapy, Combination , Hormone Replacement Therapy , Humans , Hypothyroidism , Patient Preference , Randomized Controlled Trials as Topic , Thyroxine , Triiodothyronine