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Br J Gen Pract. 2015 Feb;65(631):e121-32. doi: 10.3399/bjgp15X683569.

International variation in GP treatment strategies for subclinical hypothyroidism in older adults: a case-based survey.

Author information

1
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
2
Department of General Internal Medicine, Inselspital, University of Bern, Bern, Switzerland.
3
Institute for Evidence-Based Medicine in Old Age (IEMO), Leiden, the Netherlands, and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands.
4
Bern Institute of General Practice, University of Bern, Bern, Switzerland.
5
Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
6
Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand.
7
Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, UK.
8
Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt, Germany.
9
Institute of General Practice and Health Services Research, University of Zürich, Zürich, Switzerland.
10
Department of Primary and Community Care, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands.
11
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, UK.
12
Research Department of Primary Care and Population Health, University College London, UK.
13
Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands, and Leyden Academy on Vitality and Ageing, Leiden, the Netherlands.

Abstract

BACKGROUND:

There is limited evidence about the impact of treatment for subclinical hypothyroidism, especially among older people.

AIM:

To investigate the variation in GP treatment strategies for older patients with subclinical hypothyroidism depending on country and patient characteristics.

DESIGN AND SETTING:

Case-based survey of GPs in the Netherlands, Germany, England, Ireland, Switzerland, and New Zealand.

METHOD:

The treatment strategy of GPs (treatment yes/no, starting-dose thyroxine) was assessed for eight cases presenting a woman with subclinical hypothyroidism. The cases differed in the patient characteristics of age (70 versus 85 years), vitality status (vital versus vulnerable), and thyroid-stimulating hormone (TSH) concentration (6 versus 15 mU/L).

RESULTS:

A total of 526 GPs participated (the Netherlands n = 129, Germany n = 61, England n = 22, Ireland n = 21, Switzerland n = 262, New Zealand n = 31; overall response 19%). Across countries, differences in treatment strategy were observed. GPs from the Netherlands (mean treatment percentage 34%), England (40%), and New Zealand (39%) were less inclined to start treatment than GPs in Germany (73%), Ireland (62%), and Switzerland (52%) (P = 0.05). Overall, GPs were less inclined to start treatment in 85-year-old than in 70-year-old females (pooled odds ratio [OR] 0.74 [95% confidence interval [CI] = 0.63 to 0.87]). Females with a TSH of 15 mU/L were more likely to get treated than those with a TSH of 6 mU/L (pooled OR 9.49 [95% CI = 5.81 to 15.5]).

CONCLUSION:

GP treatment strategies of older people with subclinical hypothyroidism vary largely by country and patient characteristics. This variation underlines the need for a new generation of international guidelines based on the outcomes of randomised clinical trials set within primary care.

KEYWORDS:

general practice; subclinical hypothyroidism; survey

PMID:
25624308
PMCID:
PMC4325459
DOI:
10.3399/bjgp15X683569
[Indexed for MEDLINE]
Free PMC Article

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