RT Journal Article
SR Electronic
T1 International variation in GP treatment strategies for subclinical hypothyroidism in older adults: a case-based survey
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e121
OP e132
DO 10.3399/bjgp15X683569
VO 65
IS 631
A1 Wendy PJ den Elzen
A1 Anne A Lefèbre-van de Fliert
A1 Vanessa Virgini
A1 Simon P Mooijaart
A1 Peter Frey
A1 Patricia M Kearney
A1 Ngaire Kerse
A1 Christian D Mallen
A1 Vera JC McCarthy
A1 Christiane Muth
A1 Thomas Rosemann
A1 Audrey Russell
A1 Henk Schers
A1 David J Stott
A1 Margot WM de Waal
A1 Alex Warner
A1 Rudi GJ Westendorp
A1 Nicolas Rodondi
A1 Jacobijn Gussekloo
YR 2015
UL http://bjgp.org/content/65/631/e121.abstract
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.