PT  - JOURNAL ARTICLE
AU  - Wendy PJ den Elzen
AU  - Anne A Lefèbre-van de Fliert
AU  - Vanessa Virgini
AU  - Simon P Mooijaart
AU  - Peter Frey
AU  - Patricia M Kearney
AU  - Ngaire Kerse
AU  - Christian D Mallen
AU  - Vera JC McCarthy
AU  - Christiane Muth
AU  - Thomas Rosemann
AU  - Audrey Russell
AU  - Henk Schers
AU  - David J Stott
AU  - Margot WM de Waal
AU  - Alex Warner
AU  - Rudi GJ Westendorp
AU  - Nicolas Rodondi
AU  - Jacobijn Gussekloo
TI  - International variation in GP treatment strategies for subclinical hypothyroidism in older adults: a case-based survey
AID  - 10.3399/bjgp15X683569
DP  - 2015 Feb 01
TA  - British Journal of General Practice
PG  - e121--e132
VI  - 65
IP  - 631
4099  - http://bjgp.org/content/65/631/e121.short
4100  - http://bjgp.org/content/65/631/e121.full
SO  - Br J Gen Pract2015 Feb 01; 65
AB  - 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.