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- Title
International variation in GP treatment strategies for subclinical hypothyroidism in older adults: a case-based survey.
- Authors
den Elzen, Wendy Pj; Lefèbre-van de Fliert, Anne A; Virgini, Vanessa; Mooijaart, Simon P; Frey, Peter; Kearney, Patricia M; Kerse, Ngaire; Mallen, Christian D; McCarthy, Vera Jc; Muth, Christiane; Rosemann, Thomas; Russell, Audrey; Schers, Henk; Stott, David J; de Waal, Margot Wm; Warner, Alex; Westendorp, Rudi Gj; Rodondi, Nicolas; Gussekloo, Jacobijn; den Elzen, Wendy P J
- Abstract
<bold>Background: </bold>There is limited evidence about the impact of treatment for subclinical hypothyroidism, especially among older people.<bold>Aim: </bold>To investigate the variation in GP treatment strategies for older patients with subclinical hypothyroidism depending on country and patient characteristics.<bold>Design and Setting: </bold>Case-based survey of GPs in the Netherlands, Germany, England, Ireland, Switzerland, and New Zealand.<bold>Method: </bold>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).<bold>Results: </bold>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]).<bold>Conclusion: </bold>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.
- Publication
British Journal of General Practice, 2015, Vol 65, Issue 631, pe121
- ISSN
0960-1643
- Publication type
journal article
- DOI
10.3399/bjgp15X683569