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A1. Sex

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A2. Age (years)     

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A3. Years in medical practice 

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A4. Specialty [check all that apply]

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A5. Member of… [check all that apply]

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A6. Where do you practice? [check all that apply]

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A6bis. Are you clinically active?

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A7. Do you treat thyroid patients on a regular basis (daily or weekly)?

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A8. Do you treat patients with hypothyroidism?

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B1. Thyroid hormones may be indicated in biochemically euthyroid patients with: [check all that apply]

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B2. Which thyroid hormones available for substitution therapy should be the first choice for the treatment of hypothyroid patients?

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B3. Which of the following drugs are you prescribing in clinical practice? [check all that apply]

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B4. How much control do you have over the formulation of LT4 dispensed for your patients? Please choose the option the best applies to your practice

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B5. Interfering drugs may influence the stability of therapy. Which LT4 preparation is in your experience least likely to be subject to variable absorption?

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B6. Which of the following preparations of LT4 would you prescribe in case of first diagnosis of hypothyroidism when the patient self-reports intolerance to various foods raising the possibility of celiac disease, malabsorption, lactose intolerance, or intolerance to common excipients

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B7. Which of the following preparations of LT4 would you prescribe for a patient established on LT4 who has unexplained poor biochemical control of hypothyroidism?

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B8. Which of the following preparations of LT4 would you prescribe for a patient with poor biochemical control who is unable (due to busy lifestyle) to take LT4 fasted and separate from food/drink?

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B9. Which of the following preparations of LT4 would you prescribe for a patient established on LT4 tablets who has good biochemical control of hypothyroidism but continues to have symptoms?

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B10. After the start of LT4 replacement therapy, when would you re-check serum TSH:

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B11. In case of a switch to a different formulation or change from one manufacturer’s LT4 tablet to another, when do you recommend that the serum TSH should be re-checked:

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B12. Dietary supplements (such as selenium or iodine) are proposed for patients with thyroid disease. Do you think that they may be used in addition to thyroid hormone replacement in hypothyroidism?

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B13. The use of combined replacement therapy, with administration of both LT4 and LT3, is generally not recommended. Do you think that may be considered:

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B14. It has been reported that some patients with hypothyroidism treated with levothyroxine continue to experience persistent symptoms despite normal serum TSH. The following three questions refer to such patients.
In your clinical practice how common is this phenomenon?

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B15. It has been reported that some patients with hypothyroidism treated with levothyroxine continue to experience persistent symptoms despite normal serum TSH.
In your experience what has been the trend over the past 5 years?

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B16. In most patients treated with levothyroxine who achieve normal serum TSH, persistent symptoms are due to:

  strongly disagree disagree agree strongly agree
1) inability of levothyroxine to restore normal physiology
2) psychosocial factors
3) comorbidities
4) chronic fatigue syndrome
5) patient unrealistic expectation
6) presence of underlying inflammation due to autoimmunity
7) the burden of chronic disease
8) the burden of having to take medication

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B17. Using your experience with patients treated with levothyroxine who achieve normal serum TSH, but continue to experience symptoms like fatigue, please rank them from 1-8, where 1 is the most likely and 8 the least likely explanation in your opinion. [Attribute a score from 1 (most likely) to 8 (least likely) to each item.]

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