TOPLINE:
- Most studies of desiccated thyroid extract (DTE) in treating hypothyroidism are poorly designed, and the quality of evidence is low.
- Non-randomised studies tend to show symptom improvements with DTE compared with levothyroxine (LT4) and may reflect a placebo effect.
- Two well-designed randomised controlled trials (RCTs) did not demonstrate significant symptom improvement or quality-of-life scores between DTE and LT4 and/or LT4/liothyronine (LT3).
METHODOLOGY:
- A systematic review and meta-analysis of 14 studies, including two RCTs, nine non-randomised studies, and three case reports.
TAKEAWAY:
- In the non-randomised studies, quality-of-life scores improved with DTE, including one using the Short Form-20 questionnaire in which 92% of patients reported excellent, very good, or good self-health after initiating DTE compared with LT4, and 92.7% reported improved quality of life after switching to DTE.
- In the two RCTs, no differences were seen in the Thyroid Symptom Questionnaire for DTE compared with LT4 monotherapy and/or LT4/LT3.
- Three studies found no difference in thyroid stimulating hormone (TSH) levels between DTE and other treatment regimens, two found significantly higher TSH, one found significantly lower TSH on DTE compared to LT4 treatment, whereas in another study DTE was superior to LT4 in maintaining plasma TSH within the reference range.
- The RCTs found no differences in low-density lipoprotein cholesterol, total cholesterol, or triglycerides, whereas in one study, high-density lipoprotein cholesterol was significantly lower in DTE-treated patients, but this was not found in the other RCT.
- One RCT found increased heart rate with DTE (P = .04), while the other did not.
- In one RCT, 48.6% of patients preferred DTE, 18.6% preferred LT4, and 32.9% had no preference (P = .002), whereas the other RCT showed no difference in preference between DTE, LT4, and LT4/LT3.
IN PRACTICE:
“DTE…is no longer recommended by guidelines worldwide. The primary concern is the high content of triiodothyronine compared with the human thyroid, which potentially leads to transient hyperthyroidism,” the authors wrote. “Many patients request DTE treatment…but only 0%-5% of European endocrinologists [prescribe it. However, about] 17% of Swedish and 13% of Irish endocrinologists do sometimes prescribe DTE…Until more solid evidence is provided, the management of hypothyroid patients with persistent symptoms remains challenging…education and information of patients should be encouraged, and the development and validation of different self-management tools and point-of-care devices are also likely to prove very helpful,” they added.
SOURCE:
The study was conducted by Kamilla Ryom Riis, MD, of the Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark, and the Department of Clinical Research, University of Southern Denmark, Odense, and colleagues and published online on March 25, 2024, in Thyroid.
LIMITATIONS:
Some older studies were judged outdated and unsuitable.
DISCLOSURES:
The authors have no conflicts of interest.
Source link : https://www.medscape.com/s/viewarticle/what-do-data-say-about-desiccated-thyroid-extract-2024a10005nw?src=rss
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Publish date : 2024-03-27 14:00:00
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