Introduction Some levothyroxine unresponsive individuals with hypothyroidism are prescribed a Natural Desiccated Thyroid (NDT) preparation such as Armour Thyroid® or ERFA Thyroid®. These contain a mixture of levothyroxine and liothyronine in a fixed ratio. We evaluated the response to NDT in individuals at a single endocrine centre in terms of how the change from levothyroxine to NDT impacted on their lives in relation to quality of life (QOL) and thyroid symptoms. Methods The ThyPRO39 (thyroid symptomatology) and EQ-5D-5L-related QoL)/EQ5D5L (generic QOL) questionnaires were administered to 31 consecutive patients who had been initiated on NDT, before initiating treatment/6 months later. Results There were 28women/3men. The dose range of NDT was 60mg-180mg daily. Age range was 26-77 years with length of time since diagnosis with hypothyroidism ranging from 2-40 years. One person discontinued the NDT because of lack of response; 2 because of cardiac symptoms. EQ-5D-5L utility increased from a mean (SD) of 0.214 (0.338) at baseline, to 0.606 (0.248) after 6 months; corresponding to a difference of 0.392 (95% CI 0.241-0.542), t=6.82, p<0.001. EQ-VAS scores increased from 33.4 (17.2) to 71.1 (17.5), a difference of 37.7 (95%CI 25.2-50.2), t=-4.9, p<0.001. ThyPRO scores showed consistent fall across all domains with the composite QoL-impact Score improving from 68.3 (95%CI 60.9-75.7) to 25.2 (95%CI 18.7-31.7), a difference of 43.1 (95%CI 33. -53.2) (t=5.6, p<0.001). Conclusion Significant symptomatic benefit and improvement in QOL was experienced by people with a history of levothyroxine unresponsive hypothyroidism, suggesting the need for further evaluation of NDT in this context.

Background In order to address the COVID-19 pandemic, health systems have used all their resources, including health care workers in training. Knowing the insights of these workers is of the utmost importance to generate adequate educative/political /administrative strategies. Methods An anonymous cross-sectional online survey was made by the General Directorate of Quality and Health Education in Mexico, in a convenience sample of 6,020 participants who belong to personnel in training for the health area, which included practitioners and professional technologists, undergraduate doctors, nursing, and residents in several specialties. Results Different positive and negative feelings were identified by the health workers who participated in facing this health emergency; emphasizing elements such as the need for Personal Protection Equipment (PPE) that, when deficient or lacking, generate concerns that raise questions about the medical/epidemiological attention to the pandemic. Based on an analysis of feelings, 8 main feelings were identified, which by frequency of appearing were: distrust(24.83%), fear(21.97%), sadness(12.45%), anticipation(11.65%), anger(10.71%), disgust(9.69%), joy(4.97%) and surprise(3.72%) which influence health workers in training and their wrok performance day to day. Concerning their positive and negative evaluation of their experience facing this health emergency, 13.83% of participants had a positive perception about participating in this kind of health emergency to support the country, 49.94% showed a negative evaluation, and 36.23% kept a neutral evaluation about their participation. Conclusions The health workers in training in Mexico gave a negative evaluation of the management of the health emergency. Distrust as a response to the absence of timely information from the education/health institutions, as well as concern about lack of personal protection equipment/inputs, are the main conflicts reported. We must establish a credible globally relevant continuity plan for the education of health care personnel in training, facing emergencies and disasters, so that next time we are properly prepared.