Use of thyroid hormones in euthyroid patients with unexplained fatigue: analyses of aggregate data from European national surveys of professional endocrine society members

Tomasz Bednarczuk; Aleksandra Sugier; Roberto Attanasio; Endre V. Nagy; Roberto Negro; Enrico Papini; Miloš Žarković; Ersin Akarsu; Maria Alevizaki; Göksun Ayvaz; Biljana Nedeljković Beleslin; Eszter Berta; Miklos Bodor; Anna M. Borissova; Mihail Boyanov; Camille Buffet; Maria Cristina Burlacu; Chagit A. Cohen; Jasmina Ćirić; Juan J. Díez; Harald Dobnig; Valentin Fadeyev; Benjamin C.T. Field; Eric Fliers; Dagmar Führer-Sakel; Jacob S. Frølich; Juan C. Galofré; Tommi Hakala; Jan Jiskra; Peter A. Kopp; Michael Krebs; Michal Kršek; Martin Kužma; Ivica Lazúrová; Laurence Leenhardt; Stephen Ludgate; Vitaliy Luchytskiy; Anne McGowan; Miguel Melo; Saara Metso; Carla Moran; Tatyana Morgunova; Dan A. Niculescu; Božidar Perić; Tereza Planck; Catalina Poiana; Francisca M. Puga; Eyal Robenshtok; Patrick Rosselet; Marek Ruchala; Kamilla R. Riis; Alla Shepelkevich; Mykola D. Tronko; David Unuane; Irfan Vardarli; W. Edward Visser; Andromachi Vryonidou; Younes Ramazan Younes; Elena Yurenya; Petros Perros; Laszlo Hegedüs

doi:10.3389/fendo.2025.1713814

Use of thyroid hormones in euthyroid patients with unexplained fatigue: analyses of aggregate data from European national surveys of professional endocrine society members

Tomasz Bednarczuk^*
, Aleksandra Sugier^*
, Roberto Attanasio
, Endre V. Nagy
, Roberto Negro
, Enrico Papini
, Miloš Žarković
, Ersin Akarsu
, Maria Alevizaki
, Göksun Ayvaz
, Biljana Nedeljković Beleslin
, Eszter Berta
, Miklos Bodor
, Anna M. Borissova
, Mihail Boyanov
, Camille Buffet
, Maria Cristina Burlacu
, Chagit A. Cohen
, Jasmina Ćirić
, Juan J. Díez

Harald Dobnig, Valentin Fadeyev, Benjamin C.T. Field, Eric Fliers, Dagmar Führer-Sakel, Jacob S. Frølich, Juan C. Galofré, Tommi Hakala, Jan Jiskra, Peter A. Kopp, Michael Krebs, Michal Kršek, Martin Kužma, Ivica Lazúrová, Laurence Leenhardt, Stephen Ludgate, Vitaliy Luchytskiy, Anne McGowan, Miguel Melo, Saara Metso, Carla Moran, Tatyana Morgunova, Dan A. Niculescu, Božidar Perić, Tereza Planck, Catalina Poiana, Francisca M. Puga, Eyal Robenshtok, Patrick Rosselet, Marek Ruchala, Kamilla R. Riis, Alla Shepelkevich, Mykola D. Tronko, David Unuane, Irfan Vardarli, W. Edward Visser, Andromachi Vryonidou, Younes Ramazan Younes, Elena Yurenya, Petros Perros, Laszlo Hegedüs

^*Corresponding author for this work

Internal Medicine

Medical University of Warsaw
Scientific Committee Associazione Medici Endocrinologi (Udine)
University of Debrecen
University of Salento
Regina Apostolorum Hospital
University of Belgrade
Gaziantep University
National and Kapodistrian University of Athens
Ankara Numune Education and Research Hospital
Medical University Sofia
Sorbonne Université
Cliniques Universitaires Saint-Luc
Tel Aviv University
University Hospital Puerta de Hierro-Majadahonda
Universidad Autónoma de Madrid
Thyroid Practice and Specialty Practice for Thyroid Radiofrequency Ablation
Sechenov First Moscow State Medical University
University of Surrey
University of Amsterdam
University Hospital Essen
Odense University Hospital
University of Navarra
Navarra Medical Research Institute
Tampere University
Charles University
University of Lausanne
Medical University of Vienna
Comenius University
Pavol Jozef Šafárik University
Trinity College Dublin
Tallaght University Hospital
NAMS - Komisarenko Institute of Endocrinology and Metabolism
University of Coimbra
Beacon Hospital
University College Dublin
Carol Davila University of Medicine and Pharmacy
Sisters of Charity Hospital
Skåne University Hospital
Serviço de Endocrinologia
University of Medical Sciences Poznan
Belarusian State Medical University
Vrije Universiteit Brussel
Ruhr University Bochum
Heidelberg University
Hellenic Red Cross Hospital
Surrey and Sussex Healthcare NHS Trust
Minsk Endocrinology Medical Center
Newcastle University

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background:

Managing patients with fatigue is a clinical challenge. Because fatigue is often reported in hypothyroidism, thyroid hormone (TH) therapy may sometimes be incorrectly considered for biochemically euthyroid individuals. This study aimed to evaluate the prevalence and determinants of this practice in different European countries.

Methods:

We analyzed aggregate data from the THESIS (Treatment of Hypothyroidism in Europe by Specialists: an International Survey) online survey. We analyzed responses from 5,695 members of 28 national endocrine/thyroid societies’ specialists to the statement: “Thyroid hormones may be indicated in biochemically euthyroid patients with unexplained fatigue”.

Results:

Overall, 7.5% (426/5695) of respondents indicated that TH therapy might be considered for euthyroid patients with unexplained fatigue. The proportion of positive responses varied widely across different countries (between 1.1% in Switzerland and 29.3% in Serbia; p=2 ×10^-16) and regions (between 4.7% in Western Europe and 8.7% in Western Asia or 8.8% in Eastern Europe; p=0.004). TH were more frequently prescribed for unexplained fatigue by male respondents (Odds Ratio, OR 1.45, 95% CI 1.18-1.78) and physicians practicing in private practice (OR 1.27, 95% CI 1.02-1.58), and less frequently by endocrinologists (OR 0.62, 95% CI 0.46-0.83).

Conclusion:

A small, yet not negligible percentage of European thyroid-focused physicians consider using TH for euthyroid patients with unexplained fatigue, with significant variations based on geographic, demographic, and practice-related factors. Using levothyroxine and/or liothyronine in such cases lacks evidence and may partially contribute to the concerning overuse of TH therapy.

Original language	English
Article number	1713814
Journal	Frontiers in Endocrinology
Volume	16
DOIs	https://doi.org/10.3389/fendo.2025.1713814
Publication status	Published - 5 Nov 2025

Bibliographical note

Publisher Copyright:
Copyright © 2025 Bednarczuk, Sugier, Attanasio, Nagy, Negro, Papini, Žarković, Akarsu, Alevizaki, Ayvaz, Nedeljković Beleslin, Berta, Bodor, Borissova, Boyanov, Buffet, Burlacu, Cohen, Ćirić, Díez, Dobnig, Fadeyev, Field, Fliers, Führer-Sakel, Frølich, Galofré, Hakala, Jiskra, Kopp, Krebs, Kršek, Kužma, Lazúrová, Leenhardt, Ludgate, Luchytskiy, McGowan, Melo, Metso, Moran, Morgunova, Niculescu, Perić, Planck, Poiana, Puga, Robenshtok, Rosselet, Ruchala, Riis, Shepelkevich, Tronko, Unuane, Vardarli, Visser, Vryonidou, Younes, Yurenya, Perros and Hegedüs.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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Use of thyroid hormones in euthyroid patients with unexplained fatigueFinal published version, 1.98 MBLicence: CC BY

Cite this

Bednarczuk, T., Sugier, A., Attanasio, R., Nagy, E. V., Negro, R., Papini, E., Žarković, M., Akarsu, E., Alevizaki, M., Ayvaz, G., Nedeljković Beleslin, B., Berta, E., Bodor, M., Borissova, A. M., Boyanov, M., Buffet, C., Burlacu, M. C., Cohen, C. A., Ćirić, J., ... Hegedüs, L. (2025). Use of thyroid hormones in euthyroid patients with unexplained fatigue: analyses of aggregate data from European national surveys of professional endocrine society members. Frontiers in Endocrinology, 16, Article 1713814. https://doi.org/10.3389/fendo.2025.1713814

@article{bf44ffa08ef24447b2e831fc9e5d2e80,

title = "Use of thyroid hormones in euthyroid patients with unexplained fatigue: analyses of aggregate data from European national surveys of professional endocrine society members",

abstract = "Background: Managing patients with fatigue is a clinical challenge. Because fatigue is often reported in hypothyroidism, thyroid hormone (TH) therapy may sometimes be incorrectly considered for biochemically euthyroid individuals. This study aimed to evaluate the prevalence and determinants of this practice in different European countries. Methods: We analyzed aggregate data from the THESIS (Treatment of Hypothyroidism in Europe by Specialists: an International Survey) online survey. We analyzed responses from 5,695 members of 28 national endocrine/thyroid societies{\textquoteright} specialists to the statement: “Thyroid hormones may be indicated in biochemically euthyroid patients with unexplained fatigue”. Results: Overall, 7.5\% (426/5695) of respondents indicated that TH therapy might be considered for euthyroid patients with unexplained fatigue. The proportion of positive responses varied widely across different countries (between 1.1\% in Switzerland and 29.3\% in Serbia; p=2 ×10-16) and regions (between 4.7\% in Western Europe and 8.7\% in Western Asia or 8.8\% in Eastern Europe; p=0.004). TH were more frequently prescribed for unexplained fatigue by male respondents (Odds Ratio, OR 1.45, 95\% CI 1.18-1.78) and physicians practicing in private practice (OR 1.27, 95\% CI 1.02-1.58), and less frequently by endocrinologists (OR 0.62, 95\% CI 0.46-0.83).Conclusion: A small, yet not negligible percentage of European thyroid-focused physicians consider using TH for euthyroid patients with unexplained fatigue, with significant variations based on geographic, demographic, and practice-related factors. Using levothyroxine and/or liothyronine in such cases lacks evidence and may partially contribute to the concerning overuse of TH therapy.",

author = "Tomasz Bednarczuk and Aleksandra Sugier and Roberto Attanasio and Nagy, \{Endre V.\} and Roberto Negro and Enrico Papini and Milo{\v s} {\v Z}arkovi{\'c} and Ersin Akarsu and Maria Alevizaki and G{\"o}ksun Ayvaz and \{Nedeljkovi{\'c} Beleslin\}, Biljana and Eszter Berta and Miklos Bodor and Borissova, \{Anna M.\} and Mihail Boyanov and Camille Buffet and Burlacu, \{Maria Cristina\} and Cohen, \{Chagit A.\} and Jasmina {\'C}iri{\'c} and D{\'i}ez, \{Juan J.\} and Harald Dobnig and Valentin Fadeyev and Field, \{Benjamin C.T.\} and Eric Fliers and Dagmar F{\"u}hrer-Sakel and Fr{\o}lich, \{Jacob S.\} and Galofr{\'e}, \{Juan C.\} and Tommi Hakala and Jan Jiskra and Kopp, \{Peter A.\} and Michael Krebs and Michal Kr{\v s}ek and Martin Ku{\v z}ma and Ivica Laz{\'u}rov{\'a} and Laurence Leenhardt and Stephen Ludgate and Vitaliy Luchytskiy and Anne McGowan and Miguel Melo and Saara Metso and Carla Moran and Tatyana Morgunova and Niculescu, \{Dan A.\} and Bo{\v z}idar Peri{\'c} and Tereza Planck and Catalina Poiana and Puga, \{Francisca M.\} and Eyal Robenshtok and Patrick Rosselet and Marek Ruchala and Riis, \{Kamilla R.\} and Alla Shepelkevich and Tronko, \{Mykola D.\} and David Unuane and Irfan Vardarli and Visser, \{W. Edward\} and Andromachi Vryonidou and Younes, \{Younes Ramazan\} and Elena Yurenya and Petros Perros and Laszlo Heged{\"u}s",

note = "Publisher Copyright: Copyright {\textcopyright} 2025 Bednarczuk, Sugier, Attanasio, Nagy, Negro, Papini, {\v Z}arkovi{\'c}, Akarsu, Alevizaki, Ayvaz, Nedeljkovi{\'c} Beleslin, Berta, Bodor, Borissova, Boyanov, Buffet, Burlacu, Cohen, {\'C}iri{\'c}, D{\'i}ez, Dobnig, Fadeyev, Field, Fliers, F{\"u}hrer-Sakel, Fr{\o}lich, Galofr{\'e}, Hakala, Jiskra, Kopp, Krebs, Kr{\v s}ek, Ku{\v z}ma, Laz{\'u}rov{\'a}, Leenhardt, Ludgate, Luchytskiy, McGowan, Melo, Metso, Moran, Morgunova, Niculescu, Peri{\'c}, Planck, Poiana, Puga, Robenshtok, Rosselet, Ruchala, Riis, Shepelkevich, Tronko, Unuane, Vardarli, Visser, Vryonidou, Younes, Yurenya, Perros and Heged{\"u}s.",

year = "2025",

month = nov,

day = "5",

doi = "10.3389/fendo.2025.1713814",

language = "English",

volume = "16",

journal = "Frontiers in Endocrinology",

issn = "1664-2392",

publisher = "Frontiers Media SA",

}

Bednarczuk, T, Sugier, A, Attanasio, R, Nagy, EV, Negro, R, Papini, E, Žarković, M, Akarsu, E, Alevizaki, M, Ayvaz, G, Nedeljković Beleslin, B, Berta, E, Bodor, M, Borissova, AM, Boyanov, M, Buffet, C, Burlacu, MC, Cohen, CA, Ćirić, J, Díez, JJ, Dobnig, H, Fadeyev, V, Field, BCT, Fliers, E, Führer-Sakel, D, Frølich, JS, Galofré, JC, Hakala, T, Jiskra, J, Kopp, PA, Krebs, M, Kršek, M, Kužma, M, Lazúrová, I, Leenhardt, L, Ludgate, S, Luchytskiy, V, McGowan, A, Melo, M, Metso, S, Moran, C, Morgunova, T, Niculescu, DA, Perić, B, Planck, T, Poiana, C, Puga, FM, Robenshtok, E, Rosselet, P, Ruchala, M, Riis, KR, Shepelkevich, A, Tronko, MD, Unuane, D, Vardarli, I, Visser, WE, Vryonidou, A, Younes, YR, Yurenya, E, Perros, P & Hegedüs, L 2025, 'Use of thyroid hormones in euthyroid patients with unexplained fatigue: analyses of aggregate data from European national surveys of professional endocrine society members', Frontiers in Endocrinology, vol. 16, 1713814. https://doi.org/10.3389/fendo.2025.1713814

Use of thyroid hormones in euthyroid patients with unexplained fatigue: analyses of aggregate data from European national surveys of professional endocrine society members. / Bednarczuk, Tomasz; Sugier, Aleksandra; Attanasio, Roberto et al.
In: Frontiers in Endocrinology, Vol. 16, 1713814, 05.11.2025.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Use of thyroid hormones in euthyroid patients with unexplained fatigue

T2 - analyses of aggregate data from European national surveys of professional endocrine society members

AU - Bednarczuk, Tomasz

AU - Sugier, Aleksandra

AU - Attanasio, Roberto

AU - Nagy, Endre V.

AU - Negro, Roberto

AU - Papini, Enrico

AU - Žarković, Miloš

AU - Akarsu, Ersin

AU - Alevizaki, Maria

AU - Ayvaz, Göksun

AU - Nedeljković Beleslin, Biljana

AU - Berta, Eszter

AU - Bodor, Miklos

AU - Borissova, Anna M.

AU - Boyanov, Mihail

AU - Buffet, Camille

AU - Burlacu, Maria Cristina

AU - Cohen, Chagit A.

AU - Ćirić, Jasmina

AU - Díez, Juan J.

AU - Dobnig, Harald

AU - Fadeyev, Valentin

AU - Field, Benjamin C.T.

AU - Fliers, Eric

AU - Führer-Sakel, Dagmar

AU - Frølich, Jacob S.

AU - Galofré, Juan C.

AU - Hakala, Tommi

AU - Jiskra, Jan

AU - Kopp, Peter A.

AU - Krebs, Michael

AU - Kršek, Michal

AU - Kužma, Martin

AU - Lazúrová, Ivica

AU - Leenhardt, Laurence

AU - Ludgate, Stephen

AU - Luchytskiy, Vitaliy

AU - McGowan, Anne

AU - Melo, Miguel

AU - Metso, Saara

AU - Moran, Carla

AU - Morgunova, Tatyana

AU - Niculescu, Dan A.

AU - Perić, Božidar

AU - Planck, Tereza

AU - Poiana, Catalina

AU - Puga, Francisca M.

AU - Robenshtok, Eyal

AU - Rosselet, Patrick

AU - Ruchala, Marek

AU - Riis, Kamilla R.

AU - Shepelkevich, Alla

AU - Tronko, Mykola D.

AU - Unuane, David

AU - Vardarli, Irfan

AU - Visser, W. Edward

AU - Vryonidou, Andromachi

AU - Younes, Younes Ramazan

AU - Yurenya, Elena

AU - Perros, Petros

AU - Hegedüs, Laszlo

N1 - Publisher Copyright: Copyright © 2025 Bednarczuk, Sugier, Attanasio, Nagy, Negro, Papini, Žarković, Akarsu, Alevizaki, Ayvaz, Nedeljković Beleslin, Berta, Bodor, Borissova, Boyanov, Buffet, Burlacu, Cohen, Ćirić, Díez, Dobnig, Fadeyev, Field, Fliers, Führer-Sakel, Frølich, Galofré, Hakala, Jiskra, Kopp, Krebs, Kršek, Kužma, Lazúrová, Leenhardt, Ludgate, Luchytskiy, McGowan, Melo, Metso, Moran, Morgunova, Niculescu, Perić, Planck, Poiana, Puga, Robenshtok, Rosselet, Ruchala, Riis, Shepelkevich, Tronko, Unuane, Vardarli, Visser, Vryonidou, Younes, Yurenya, Perros and Hegedüs.

PY - 2025/11/5

Y1 - 2025/11/5

N2 - Background: Managing patients with fatigue is a clinical challenge. Because fatigue is often reported in hypothyroidism, thyroid hormone (TH) therapy may sometimes be incorrectly considered for biochemically euthyroid individuals. This study aimed to evaluate the prevalence and determinants of this practice in different European countries. Methods: We analyzed aggregate data from the THESIS (Treatment of Hypothyroidism in Europe by Specialists: an International Survey) online survey. We analyzed responses from 5,695 members of 28 national endocrine/thyroid societies’ specialists to the statement: “Thyroid hormones may be indicated in biochemically euthyroid patients with unexplained fatigue”. Results: Overall, 7.5% (426/5695) of respondents indicated that TH therapy might be considered for euthyroid patients with unexplained fatigue. The proportion of positive responses varied widely across different countries (between 1.1% in Switzerland and 29.3% in Serbia; p=2 ×10-16) and regions (between 4.7% in Western Europe and 8.7% in Western Asia or 8.8% in Eastern Europe; p=0.004). TH were more frequently prescribed for unexplained fatigue by male respondents (Odds Ratio, OR 1.45, 95% CI 1.18-1.78) and physicians practicing in private practice (OR 1.27, 95% CI 1.02-1.58), and less frequently by endocrinologists (OR 0.62, 95% CI 0.46-0.83).Conclusion: A small, yet not negligible percentage of European thyroid-focused physicians consider using TH for euthyroid patients with unexplained fatigue, with significant variations based on geographic, demographic, and practice-related factors. Using levothyroxine and/or liothyronine in such cases lacks evidence and may partially contribute to the concerning overuse of TH therapy.

AB - Background: Managing patients with fatigue is a clinical challenge. Because fatigue is often reported in hypothyroidism, thyroid hormone (TH) therapy may sometimes be incorrectly considered for biochemically euthyroid individuals. This study aimed to evaluate the prevalence and determinants of this practice in different European countries. Methods: We analyzed aggregate data from the THESIS (Treatment of Hypothyroidism in Europe by Specialists: an International Survey) online survey. We analyzed responses from 5,695 members of 28 national endocrine/thyroid societies’ specialists to the statement: “Thyroid hormones may be indicated in biochemically euthyroid patients with unexplained fatigue”. Results: Overall, 7.5% (426/5695) of respondents indicated that TH therapy might be considered for euthyroid patients with unexplained fatigue. The proportion of positive responses varied widely across different countries (between 1.1% in Switzerland and 29.3% in Serbia; p=2 ×10-16) and regions (between 4.7% in Western Europe and 8.7% in Western Asia or 8.8% in Eastern Europe; p=0.004). TH were more frequently prescribed for unexplained fatigue by male respondents (Odds Ratio, OR 1.45, 95% CI 1.18-1.78) and physicians practicing in private practice (OR 1.27, 95% CI 1.02-1.58), and less frequently by endocrinologists (OR 0.62, 95% CI 0.46-0.83).Conclusion: A small, yet not negligible percentage of European thyroid-focused physicians consider using TH for euthyroid patients with unexplained fatigue, with significant variations based on geographic, demographic, and practice-related factors. Using levothyroxine and/or liothyronine in such cases lacks evidence and may partially contribute to the concerning overuse of TH therapy.

UR - https://www.scopus.com/pages/publications/105022628672

U2 - 10.3389/fendo.2025.1713814

DO - 10.3389/fendo.2025.1713814

M3 - Article

C2 - 41268166

AN - SCOPUS:105022628672

SN - 1664-2392

VL - 16

JO - Frontiers in Endocrinology

JF - Frontiers in Endocrinology

M1 - 1713814

ER -

Use of thyroid hormones in euthyroid patients with unexplained fatigue: analyses of aggregate data from European national surveys of professional endocrine society members

Abstract

Bibliographical note

UN SDGs

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