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A 2016 clinical practice pattern in the management of primary hypothyroidism among doctors from different clinical specialties in New Delhi

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Dutta, Deep, Surana, Vineet, Aggarwal, Sameer, Khandelwal, Deepak, Singla, Rajiv, Bhattacharya, Saptarshi, Chittawar, Sachin, Kalra, Sanjay·2017·Indian Journal of Endocrinology and Metabolism
DOI 10.4103/2230-8210.196012PMC PMC5240060
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Abstract

Background: This study aimed to document practices in managing hypothyroidism among doctors in New Delhi, with special focus on subclinical hypothyroidism, pregnancy, and old age, and to compare it with global practices. Methods: During an academic program attended by 394 doctors, all participants were given a questionnaire designed based on thyroid practices survey done by Burch et al. to evaluate the practice patterns. Questions were based on evaluating doctor's preferred choices in diagnosis, therapy, and follow-up of hypothyroidism in different scenarios. Results: Responses from 308 questionnaires (general physicians [n = 204], obstetricians [n = 51], pediatricians [n = 27], surgeons [n = 12], endocrinologists [n = 10], and others [n = 4]) were analyzed. In the evaluation of 52-year-old female patient with primary hypothyroidism, 52% doctors would prefer thyroid ultrasonography, comparable to global rates. Nearly 96.1% doctors would have initiated levothyroxine, with a large majority of doctors (83.77%) preferred using branded levothyroxine. About 58.74% doctors preferred gradual restoration of euthyroidism. Levothyroxine dose of 25 mcg was the most preferred increment dose (46.07%) during follow-up, with 6 weekly being the most frequent dose adjustment frequency (41.57%). Most preferred target thyroid-stimulating hormone (TSH) in the 52-year-old female patient was 2.5–4.99 mU/L (63.96%), 25-year-old female patient was 1–2.49 mU/L (53.90%), and in 85-year-old female was 2.5–4.99 mU/L (45.45%). Only 68% of doctors in our study preferred keeping TSH <2.5 mU/L during the first trimester of pregnancy, in contrast to global trends of 95% (P < 0.001). Conclusion: There was a disproportionately high use of ultrasonography in hypothyroidism management, near exclusive preference for branded levothyroxine, widespread use of age-specific TSH targets, and low threshold for treating mild thyroid failure, a highly variable approach to both rates and means of restoring euthyroidism for overt primary hypothyroidism. There is a need for spreading awareness regarding TSH targets in pregnancy.

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  • A 2016 study showed that 4.2% of physicians would prescribe combination therapy for a patient with persistent symptoms consistent with hypothyroidism.

    “A study conducted 3 years later in 2016 also showed that 4.2% of physicians would prescribe combination therapy for a patient with persistent symptoms consistent with hypothyroidism (33).”

    From Short-Term Time Trends in Prescribing Therapy for Hypothyroidism: Results of a Survey of American Thyroid Association Members (2019) · cites this paper as [33]

    The Results section on preferred thyroid hormone preparations reports that 7 of 308 doctors (2.27%) used levothyroxine–liothyronine combination therapy. The separate Results section on persistent symptoms does not report 4.2% prescribing combination therapy for that patient; it says 87.01% preferred evaluation for other causes. No page numbers are available in our copy. (LLM, conf=0.83)

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Authors
Dutta, D., Surana, V., Aggarwal, S., Khandelwal, D., Singla, R., Bhattacharya, S., Chittawar, S., & Kalra, S.
Affiliations
Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (IN)
Corresponding author
Dutta, Deep
ORCID
Venue
Indian Journal of Endocrinology and Metabolism
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2017
Volume
21
Issue
1
Pages
165
ISSN
2230-8210 (ISSN-L)
DOI
10.4103/2230-8210.196012
PMC
PMC5240060
OpenAlex
W2566805452
Cited by
14
References
20
Citations by year
2026: 1 · 2025: 1 · 2024: 1 · 2023: 1 · 2022: 2 · 2021: 1 · 2019: 2 · 2018: 3 · 2017: 2
FWCI
2.35
Type
journal article
Language
en
Open access
Licence
cc-by-nc-sa
Locations
  • Indian Journal of Endocrinology and Metabolism (publishedVersion, cc-by-nc-sa)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-sa)
  • PubMed Central (publishedVersion, cc-by-nc-sa)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
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
clinical practice patterns, subclinical hypothyroidism, pregnancy, elderly patients, levothyroxine, thyroid ultrasound, first trimester, brand preference, dose adjustment, thyroid function tests, physician survey

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