Use of the 36-Point Thyroid Symptom Questionnaire to Potentially Guide Optimal Thyroid Hormone Replacement Therapy
Authors' conclusion
The TSQ-36 can potentially be used to quantify patient symptoms and guide thyroid hormone therapy. Patients on LT4, with moderate-to-severe symptoms despite normalization of thyroid stimulating hormone, could consider a trial of combination therapy. Patients with low symptoms on LT4 should generally avoid combination therapy.
Study context
- Population
- Hypothyroid patients on thyroid hormone therapy with normal TSH, stratified by Thyroid Symptom Questionnaire (TSQ-36) on levothyroxine (LT4): Low (0–12), Moderate (13–24), High (25–36) symptoms
- Participants
- 143 patients2 crossover studies
- Comparison
- LT4 vs desiccated thyroid extract (DTE) vs LT4+LT3, stratified by TSQ-36 score on LT4
- Primary endpoint
- Change in TSQ-36 score on transition from LT4 to combination therapy
- Follow-up
- End of each treatment period
Methodological detailsdouble-blind
- Double-blind
Primary result
As reported in the abstract
Mean TSQ-36 score by symptom subgroup on LT4
- DTE vs LT4: P = 0.01
- DTE vs LT4: P < 0.01
- LT4+LT3 vs LT4: P < 0.001
- DTE vs LT4: P = 0.02
- LT4 vs DTE: P = 0.03
- LT4 vs LT4+LT3: P = 0.02
- Post hoc subgroup analysis
Further findings
Treatment-blinded preference of therapy by TSQ-36 on LT4
- Patients preferring combination therapy had significantly higher TSQ-36 scores than those preferring LT4
Original publication
Use of the 36-Point Thyroid Symptom Questionnaire to Potentially Guide Optimal Thyroid Hormone Replacement Therapy. Endocr Pract. Published 12 September 2025. doi:10.
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