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- Title
Adequacy of thyroid hormone replacement in a general population.
- Authors
Okosieme, O.E.; Belludi, G.; Spittle, K.; Kadiyala, R.; Richards, J.
- Abstract
Background: Suboptimal thyroid hormone replacement may carry harmful health consequences.Aims: Our objectives were to determine the prevalence and factors associated with inadequate replacement in patients receiving treatment with levothyroxine.Design: Retrospective general practice audit.Methods: We identified levothyroxine users through electronic searches of primary care records in all 11 practices within a county borough. The adequacy of thyroid hormone replacement was determined from the current serum, serum thyrotropin (TSH) as: (i) adequate replacement (normal TSH; 0.4–4.0 mU/l); (ii) over replacement (low TSH; <0.4 mU/l); and (iii) under replacement (high TSH; >4.0 mU/l).Results: Out of a registered patient population of 58 567, we identified 1037 patients who were first included in the hypothyroidism disease register between January 2004 and December 2009 (mean age 62.4 ± 15.9 years; female 85.9%, male 14.1%). Inadequate replacement was seen in 385 patients (37.2%), comprising 205 patients (19.8%) with over replacement and 180 patients (17.4%) with under replacement. Step-wise logistic regression showed that the factors associated with under replacement were male gender [odds ratio (OR) 2.85, confidence interval (CI) 1.86–4.38; P < 0.001 and younger age (OR 0.88, CI 0.80–0.98; P = 0.02 per 10 year increase in age) while longer duration of treatment was associated with over-treatment (OR 1.06, CI 1.01–1.10). A thyroid function test was performed in the preceding 12 months in 914 patients (88.1%) and appropriate dose adjustments had been made in 81.0% (312/385) of patients with abnormal results.Conclusions: Despite frequent monitoring and dose adjustment activities, inadequate thyroid hormone replacement remained a problem in over a third of levothyroxine users in this population.
- Subjects
THYROID hormones; HORMONE therapy; THYROXINE; PRIMARY care; THYROTROPIN; THYROID gland function tests
- Publication
QJM: An International Journal of Medicine, 2011, Vol 104, Issue 5, p395
- ISSN
1460-2725
- Publication type
Article
- DOI
10.1093/qjmed/hcq222