International variation in GP treatment strategies for subclinical hypothyroidism in older adults: a case-based survey
Open accessAbstract
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.
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Unexplained variation in practice patterns has been shown for other thyroid disorders, such as thyroid cancer and subclinical hypothyroidism.
“Unexplained variation in practice patterns has been shown for other thyroid disorders, such as thyroid cancer (37) and subclinical hypothyroidism (38,39).”
From Short-Term Time Trends in Prescribing Therapy for Hypothyroidism: Results of a Survey of American Thyroid Association Members (2019) · cites this paper as [39]
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Cites
Cooper, D. S., & Biondi, B. (2012) · The Lancet · doi:10.1016/s0140-6736(11)60276-6 · Cited by 1,039 · see citing works
Gencer, B., Collet, T.-H., Virgini, V., Bauer, D. C., Gussekloo, J., Cappola, A. R., Nanchen, D., den Elzen, W. P. J., Balmer, P., Luben, R. N., et al. (2012) · Circulation · doi:10.1161/circulationaha.112.096024 · Cited by 517 · see citing works
Self-citationThyroid hormone replacement for subclinical hypothyroidism
Villar, H. C. C. E., Saconato, H., Valente, O., & Atallah, Á. N. (2007) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003419.pub2 · Cited by 329 · see citing works
Subclinical hypothyroidism and functional mobility in older adults
Simonsick, E. M. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.392 · Cited by 129 · see citing works
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Research works printed but not linked: 16
- Jones DD, May KE, Geraci SA. Subclinical thyroid disease. Am J Med 2010; 123(6): 502-504.
- Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002; 87(2): 489-499.
- Rodondi N, den Elzen WP, Bauer DC, et al. Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA 2010; 304(12): 1365-1374.
- Wilson S, Parle JV, Roberts LM, et al. Prevalence of subclinical thyroid dysfunction and its relation to socioeconomic deprivation in the elderly: a community-based cross-sectional survey. J Clin Endocrinol Metab 2006; 91(12): 4809-4816.
- Vanderpump MP, Tunbridge WM, French JM, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf) 1995; 43(1): 55-68.
- Somwaru LL, Rariy CM, Arnold AM, Cappola AR. The natural history of subclinical hypothyroidism in the elderly: the cardiovascular health study. J Clin Endocrinol Metab 2012; 97(6): 1962-1969.
- Reuters VS, Teixeira PF, Vigario PS, et al. Functional capacity and muscular abnormalities in subclinical hypothyroidism. Am J Med Sci 2009; 338(4): 259-263.
- Vigário P, Teixeira P, Reuters V, et al. Perceived health status of women with overt and subclinical hypothyroidism. Med Princ Pract 2009; 18(4): 317-322.
- Gussekloo J, van Exel E, de Craen AJ, et al. Thyroid status, disability and cognitive function, and survival in old age. JAMA 2004; 292(21): 2591-2599.
- Surks MI, Ortiz E, Daniels GH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA 2004; 291(2): 228-238.
- Van Lieshout J, Felix-Schollaart B, Bolsius EJM, et al. NHG Standaard Schildklieraandoeningen (tweede herziening) [Thyroid disorders guideline of the Dutch College of General Practitioners (NHG) (2nd revision)]. Huisarts Wet 2013; 56(7): 320-330.
- DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7(3): 177-188.
- McDermott MT, Haugen BR, Lezotte DC, et al. Management practices among primary care physicians and thyroid specialists in the care of hypothyroid patients. Thyroid 2001; 11(8): 757-764.
- Allport J, McCahon D, Hobbs FD, Roberts LM. Why are GPs treating subclinical hypothyroidism? Case note review and GP survey. Prim Health Care Res Dev 2013; 14(2): 175-184.
- Gibbons V, Lillis S, Conaglen J, Lawrenson R. The reality of subclinical hypothyroidism in general practice. J Prim Health Care 2009; 1(3): 215-221.
- Viniol A, Bosner S, Baum E, Donner-Banzhoff N. Forgotten drugs: long-term prescriptions of thyroid hormones -a cross-sectional study. Int J Gen Med 2013; 6: 329-334.
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Mooijaart, S. P., Du Puy, R. S., Stott, D. J., Kearney, P. M., Rodondi, N., Westendorp, R. G. J., den Elzen, W. P. J., Postmus, I., Poortvliet, R. K. E., van Heemst, D., et al. (2019) · JAMA · doi:10.1001/jama.2019.17274 · Cited by 121 · see citing works
Self-citationPrescribing Therapy for Hypothyroidism: Influence of Physician Characteristics
Jonklaas, J., Tefera, E., & Shara, N. (2019) · Thyroid · doi:10.1089/thy.2018.0369 · Cited by 31 · see citing works
Jonklaas, J., Tefera, E., & Shara, N. (2019) · Frontiers in Endocrinology · doi:10.3389/fendo.2019.00031 · Cited by 23 · see citing works
- Authors
- den Elzen, W. P., Lefèbre-van de Fliert, A. A., Virgini, V., Mooijaart, S. P., Frey, P., Kearney, P. M., Kerse, N., Mallen, C. D., McCarthy, V. J., Muth, C., Rosemann, T., Russell, A., Schers, H., Stott, D. J., de Waal, M. W., Warner, A., Westendorp, R. G., Rodondi, N., & Gussekloo, J.
- Affiliations
- University of Bern (CH)
- Leiden University Medical Center (NL)
- University College Cork (IE)
- University of Auckland (NZ)
- Arthritis Research UK (GB)
- Goethe University Frankfurt (DE)
- University of Zurich (CH)
- Radboud University Medical Center (NL)
- University of Glasgow (GB)
- University College London (GB)
- ORCID
- Venue
- British Journal of General Practice
- Published
- 2015-01-26
- Volume
- 65
- Issue
- 631
- Pages
- e121-e132
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC4325459
- OpenAlex
- W1977151944
- Cited by
- 18
- References
- 4
- Citations by year
- 2024: 1 · 2023: 2 · 2022: 1 · 2021: 1 · 2020: 2 · 2019: 2 · 2018: 2 · 2017: 3 · 2016: 1 · 2015: 2 · 2014: 1
- FWCI
- 2.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of General Practice (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- Keele Research Repository (Keele University) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Funders
- National Science Foundation
- University of Bern
- National Institute for Health and Care Research (RP_2014-04-026)
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (138267, 278148, 320030)
- ZonMw (627001001)
- Hôpitaux Universitaires de Genève
- Université de Lausanne
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- subclinical hypothyroidism, older adults, general practitioners, treatment decision-making, thyroxine, thyroid-stimulating hormone, international variation, primary care guidelines, vulnerable patients
- MeSH terms
- Aged, Aged, 80 and over, Female, Humans, Hypothyroidism, Male, Practice Patterns, Physicians', Surveys and Questionnaires, Thyrotropin, Practice Guidelines as Topic
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