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Differences in thyroid hormone prescribing practices between Japan Thyroid Association-certified thyroid specialists and non-certified members: a nationwide survey in Japan

Lookup NU author(s): Dr Petros PerrosORCiD

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).

Abstract

© The Japan Endocrine Society.Thyroid hormone (TH) prescribing practices, particularly on hypothyroid and euthyroid patients, were compared between Japan Thyroid Association (JTA)-certified thyroid specialists and non-certified members. A nationwide questionnaire survey (Treatment of Hypothyroidism in Europe by Specialists: An International Survey) was conducted among all 2,938 JTA members, including 874 certified specialists and 2,064 non-certified members, to assess self-reported TH prescription choices in various clinical scenarios. Responses from certified specialists and non-certified members were statistically compared. A total of 207 certified specialists (23.7%) and 129 non-certified members (6.3%) responded and completed the questionnaire. Although all certified specialists and non-certified members selected levothyroxine (LT4) as first-line therapy for hypothyroidism, certified specialists more often used liothyronine (LT3) plus LT4 combination therapy than non-certified members (28% vs. 12%, p < 0.001), particularly for LT4-treated patients with persistent hypothyroid-like symptoms (9% vs. 2%, p = 0.02). For euthyroid individuals, 71% of certified specialists and 60% of non-certified members considered TH treatment (p = 0.043). Non-certified members who see >100 hypothyroid patients per year were more inclined to use combination therapy for hypothyroid patients and TH for euthyroid patients than those of ≤100 patients (p < 0.049 and 0.001, respectively). In conclusion, JTA-certified thyroid specialists and non-certified members exhibit distinct TH prescribing patterns. Certified specialists are more open to combination therapy and treating selected euthyroid patients, whereas non-certified members favor guideline-based LT4 monotherapy. These differences underscore the impact of specialization on clinical practice and suggest a need for updated guidelines and targeted education to rationalize thyroid care.

Publication metadata

Author(s): Nagayama Y, Tajiri J, Murakami T, Watanabe N, Sato S, Shindo H, Tachibana S, Attanasio R, Papini E, Perros P, Nagy EV, Hegedus L, Ito K, Yamashita H

Publication type: Article

Publication status: Published

Journal: Endocrine Journal

Year: 2026

Volume: 73

Issue: 3

Pages: 429-438

Print publication date: 02/03/2026

Online publication date: 11/11/2025

Acceptance date: 08/10/2025

Date deposited: 16/03/2026

ISSN (print): 0918-8959

ISSN (electronic): 1348-4540

Publisher: Japan Endocrine Society

URL: https://doi.org/10.1507/endocrj.EJ25-0466

DOI: 10.1507/endocrj.EJ25-0466

PubMed id: 41224354

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