[Features of the use of synthetic analogues of thyroid hormones: а 2020 THESIS* questionnaire survey of members of the Belarusian Public Medical Association of Endocrinology and Metabolism]. — CFSMEATLAS
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[Features of the use of synthetic analogues of thyroid hormones: а 2020 THESIS* questionnaire survey of members of the Belarusian Public Medical Association of Endocrinology and Metabolism].
Shepelkevich, A P, Dydyshka, Yu V, Yurenya, E V et al. · Problemy endokrinologii · 2021 · DOI
Quick Summary
This survey asked 146 Belarusian doctors how they treat thyroid problems. Most doctors use levothyroxine (LT4) as the first treatment for low thyroid function. Some doctors said they might add a second thyroid hormone (LT3) for patients who keep feeling tired and unwell even after their blood tests show normal thyroid levels. The doctors noted that when patients have normal thyroid tests but ongoing symptoms, the cause is often stress, other health problems, or unrealistic expectations rather than actual thyroid disease.
Why It Matters
This study is relevant to ME/CFS patients because it documents physician recognition that some patients experience persistent fatigue and systemic symptoms despite normalized thyroid function tests—a pattern that overlaps with ME/CFS presentations. The finding that doctors attribute such symptoms to fatigue syndrome and chronic illness burden rather than thyroid disease suggests potential missed diagnostic opportunities or the possibility that thyroid dysfunction and ME/CFS may coexist or interact in ways not fully understood.
Observed Findings
99.3% of surveyed endocrinologists use LT4 monotherapy as first-line treatment for hypothyroidism
41.8% of doctors consider LT3+LT4 combination therapy for long-standing untreated hypothyroidism
10.3% of doctors would consider LT3+LT4 for patients with persistent symptoms despite biochemical euthyroidism on LT4
Physicians attributed persistent symptoms with normal TSH primarily to psychosocial factors, comorbidities, chronic fatigue syndrome, and disease burden rather than ongoing thyroid dysfunction
Most endocrinologists do not expect significant clinical differences between tablet, soft-gel capsule, or liquid formulations of levothyroxine
Inferred Conclusions
LT4 replacement therapy is the standard treatment choice for hypothyroidism in Belarusian endocrinology practice
Combination LT3+LT4 therapy may be considered in select clinical situations but remains uncommon
Persistent fatigue and systemic symptoms in biochemically euthyroid patients are more likely attributed to non-thyroidal causes including chronic fatigue syndrome
Thyroid hormone therapy is not routinely indicated for euthyroid patients unless specific clinical features are present
Remaining Questions
Does combination LT3+LT4 therapy actually improve symptoms in patients with persistent complaints despite normalized TSH, and if so, which patients benefit most?
What This Study Does Not Prove
This study does not prove that thyroid hormone treatment is effective for ME/CFS, nor does it establish whether ME/CFS patients have undiagnosed thyroid disorders. The survey captures only physician opinions, not actual patient outcomes or whether adding LT3 therapy actually improves symptoms in any patient population. Cross-sectional questionnaire data cannot demonstrate causation or the prevalence of thyroid-related problems in ME/CFS cohorts.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
What proportion of ME/CFS patients have underlying or coexisting thyroid dysfunction that might benefit from thyroid hormone optimization?
Can the persistent symptoms in biochemically euthyroid patients be reliably distinguished between true thyroid insufficiency, ME/CFS, and other comorbidities?
Why do some patients experience symptom persistence despite normalized biochemical markers, and does tissue-level thyroid hormone availability differ from serum levels?