CAPT(ret) Thanh D. Hoang, DO, MACP, FACE
Professor of Medicine, Uniformed Services University of the Health Sciences
Director, Endocrinology Division, Uniformed Services University of the Health Sciences
Walter Reed National Military Medical Center
Endocrinology, Diabetes & Metabolism
Bethesda, MD
Can you please let us know a little bit about yourself, including your previous affiliations and experience at the Uniformed Services University of the Health Sciences treating patients with thyroid disease, especially hypothyroidism?
Can you highlight some of the most important dimensions of the disease burden associated with hypothyroidism, including decisions related to treatment options and identification of patients who may be refractory to usual therapy?
What are the foundational thyroid function laboratory abnormalities that confirm the diagnosis of hypothyroidism; and, once the diagnosis has been made, what are the guideline-directed treatment strategies that should be implemented initially ...
Once you’ve started a patient on T4 monotherapy, how do you monitor the patient, with a focus on (a) laboratory parameters of thyroid function and (b) judging whether or not you’ve achieved an acceptable or, even, optimal, clinical response ...
Can you provide a perspective on what subset of patients treated with guideline-directed T4 monotherapy may continue to have persistent hypothyroid symptoms, how large this subpopulation is based on clinical studies, and how you rule out ...
What exactly is the composition of DTE, how does it differ from montherapeutic agents used to treat hypothyroidism, and what is its currently regulatory status?
Once a clinician makes the decision to transition/commit a patient to DTE-based thyroid hormone replacement, what do the trials/studies teach us about the comparative treatment, response rates, patient preferences, and outcomes when T4 ...
In light of positive clinical studies, how do you navigate the clinical decision tree in which you have to identify persons with hypothyroidism who are not meeting all your clinical objectives on T4 monotherapy and who may be candidates for DTE?
Can you discuss in detail what questions appear on the questionnaire you use to evaluate the success of thyroid hormone replacement therapy and whether, based on these results, a trial of combination therapy with DTE is warranted?
How do you decide in those patients in whom you believe combination T4/T3 therapy may be beneficial, whether you add T3 to T4 monotherapy or whether you commit you patients to DTE as the primary strategy for combination therapy?
Can you summarize your current recommendations and clinical pathway for patient populations who may benefit from DTE? How do you optimize treatment dosing/titration of DTE to achieve the results you are looking for?