TY - JOUR 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 SP - e121 LP - e132 DO - 10.3399/bjgp15X683569 VL - 65 IS - 631 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 Y1 - 2015/02/01 UR - http://bjgp.org/content/65/631/e121.abstract N2 - 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. ER -