Clinical Use and Perception About Synthetic Liothyronine for the Treatment of Primary Hypothyroidism Among Healthcare Professionals in India.

Abstract

Introduction: Hypothyroidism is commonly managed with levothyroxine (LT4) monotherapy, the standard treatment for many decades. However, 5%-10% of patients remain symptomatic despite achieving biochemical euthyroidism on LT4 monotherapy. Liothyronine (LT3), a synthetic form of T3, was introduced in India in 2022 but faces limited adoption due to availability, cost, and lack of clear guidelines. This study aimed to assess the perceptions, clinical usage, and barriers to LT3 prescription among healthcare professionals in India.

Methods: A cross-sectional, questionnaire-based study was conducted among 455 doctors attending three endocrinology updates in Delhi, Bhopal, and Rohtak. The participants completed a 19-question structured online survey assessing demographics, LT3 awareness, usage patterns, and barriers. The responses were analysed using SPSS version 20.

Results: Out of 455 respondents (42.15 ± 11.41 years), 80% were males and 27.69% were endocrinologists. LT3 awareness was reported by 80%, with 52.75% reported prescribed it, most commonly for hypothyroid emergencies (40.42%), rapid symptom control (22.50%), or persistent symptoms despite biochemical euthyroidism on LT4 monotherapy (17.50%). However, the major barriers included high cost (23.52%) and limited availability (22.86%). Among prescribers, 62.08% used once-daily dosing. Also, 74.29% of participants expressed interest in further learning about LT3.

Conclusion: Reported use of LT3 in India remains limited, driven by poor awareness among clinicians, cost, and availability issues. Although awareness is high among specialists, consistent guidelines, clinician education, and accessibility improvements are needed for safe and effective LT3 integration into hypothyroidism management.