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Is there a role for Natural Desiccated Thyroid in the treatment of levothyroxine unresponsive hypothyroidism? Results from a Consecutive Case Series
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  • Adrian Heald,
  • Lakdasa Premawardhana,
  • Peter N. Taylor,
  • Onyebuchi Okosieme,
  • Tasneem Bangi,
  • Holly Devine,
  • Mark Livingston,
  • Ahmed Javed,
  • Gabriela Moreno,
  • Torquil Watt,
  • Mike Stedman,
  • Colin Dayan,
  • Dyfrig Hughes
Adrian Heald
Salford Royal Hospitals NHS Trust

Corresponding Author:[email protected]

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Lakdasa Premawardhana
University of Wales Cardiff
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Peter N. Taylor
Cardiff Univ
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Onyebuchi Okosieme
University of Wales Cardiff
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Tasneem Bangi
Salford Royal Hospital
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Holly Devine
Salford Royal Hospital
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Mark Livingston
Walsall Healthcare NHS Trust
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Ahmed Javed
Salford Royal Hospital
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Gabriela Moreno
Secretaria de Salud de Mexico
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Torquil Watt
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Mike Stedman
Res Consortium
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Colin Dayan
University of Wales Cardiff
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Dyfrig Hughes
Bangor University
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Introduction Some levothyroxine unresponsive individuals with hypothyroidism are prescribed a Natural Desiccated Thyroid (NDT) preparation such as Armour Thyroid® or ERFA Thyroid®. These contain a mixture of levothyroxine and liothyronine in a fixed ratio. We evaluated the response to NDT in individuals at a single endocrine centre in terms of how the change from levothyroxine to NDT impacted on their lives in relation to quality of life (QOL) and thyroid symptoms. Methods The ThyPRO39 (thyroid symptomatology) and EQ-5D-5L-related QoL)/EQ5D5L (generic QOL) questionnaires were administered to 31 consecutive patients who had been initiated on NDT, before initiating treatment/6 months later. Results There were 28women/3men. The dose range of NDT was 60mg-180mg daily. Age range was 26-77 years with length of time since diagnosis with hypothyroidism ranging from 2-40 years. One person discontinued the NDT because of lack of response; 2 because of cardiac symptoms. EQ-5D-5L utility increased from a mean (SD) of 0.214 (0.338) at baseline, to 0.606 (0.248) after 6 months; corresponding to a difference of 0.392 (95% CI 0.241-0.542), t=6.82, p<0.001. EQ-VAS scores increased from 33.4 (17.2) to 71.1 (17.5), a difference of 37.7 (95%CI 25.2-50.2), t=-4.9, p<0.001. ThyPRO scores showed consistent fall across all domains with the composite QoL-impact Score improving from 68.3 (95%CI 60.9-75.7) to 25.2 (95%CI 18.7-31.7), a difference of 43.1 (95%CI 33. -53.2) (t=5.6, p<0.001). Conclusion Significant symptomatic benefit and improvement in QOL was experienced by people with a history of levothyroxine unresponsive hypothyroidism, suggesting the need for further evaluation of NDT in this context.
10 Aug 2021Submitted to International Journal of Clinical Practice
10 Aug 2021Submission Checks Completed
10 Aug 2021Assigned to Editor
13 Aug 2021Reviewer(s) Assigned
24 Aug 2021Review(s) Completed, Editorial Evaluation Pending
30 Aug 2021Editorial Decision: Revise Minor
19 Sep 20211st Revision Received
20 Sep 2021Submission Checks Completed
20 Sep 2021Assigned to Editor
20 Sep 2021Review(s) Completed, Editorial Evaluation Pending
23 Sep 2021Reviewer(s) Assigned
06 Oct 2021Editorial Decision: Accept
20 Nov 2021Published in International Journal of Clinical Practice. 10.1111/ijcp.14967