Variation in treatment strategies of Swiss general practitioners for subclinical hypothyroidism in older adults
QUESTIONS UNDER STUDY: As the best management of subclinical hypothyroidism is controversial, we aimed to assess variations in treatment strategies depending on different Swiss regions, physician and patient characteristics. METHODS: We performed a case-based survey among general practit...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SMW supporting association (Trägerverein Swiss Medical Weekly SMW)
2015-07-01
|
| Series: | Swiss Medical Weekly |
| Subjects: | |
| Online Access: | https://www.smw.ch/index.php/smw/article/view/2052 |
| _version_ | 1811289149847633920 |
|---|---|
| author | Christine Baumgartner Wendy P. J. den Elzen Manuel R. Blum Michael Coslovsky Sven Streit Peter Frey Lilli Herzig Dagmar M. Haller Simon P. Mooijaart Thomas Bischoff Thomas Rosemann Jacobijn Gussekloo Nicolas Rodondi |
| author_facet | Christine Baumgartner Wendy P. J. den Elzen Manuel R. Blum Michael Coslovsky Sven Streit Peter Frey Lilli Herzig Dagmar M. Haller Simon P. Mooijaart Thomas Bischoff Thomas Rosemann Jacobijn Gussekloo Nicolas Rodondi |
| author_sort | Christine Baumgartner |
| collection | DOAJ |
| description |
QUESTIONS UNDER STUDY: As the best management of subclinical hypothyroidism is controversial, we aimed to assess variations in treatment strategies depending on different Swiss regions, physician and patient characteristics.
METHODS: We performed a case-based survey among general practitioners (GPs) in different Swiss regions, which consisted of eight hypothetical cases presenting a female patient with subclinical hypothyroidism and nonspecific complaints differing by age, vitality status and thyroid-stimulating hormone (TSH) concentration.
RESULTS: A total of 262 GPs participated in the survey. There was considerable variation in the levothyroxine starting dose chosen by GPs, ranging from 25 µg to 100 µg. Across the Swiss regions, GPs in the Bern region were significantly more inclined to treat, with a higher probability of initiating treatment (60%, p = 0.01) and higher mean starting doses (45 µg, p <0.01) compared with the French-speaking region (44%, 36 µg); the Zurich region had intermediate values (52%, 39 µg). We found no association between treatment rate and other physician characteristics. GPs were more reluctant to initiate treatment in 85-year-old than in 70-year-old women (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.63–0.94), and more likely to treat women with a TSH of 15 mU/l than those with a TSH of 6mU/l (OR 8.71, 95% CI 6.21–12.20).
CONCLUSIONS: There are strong variations in treatment strategies for elderly patients with subclinical hypothyroidism across different Swiss regions, including use of higher starting doses than the recommended 25 µg in the Swiss guidelines, which recommend a starting dose of 25 µg. These variations likely reflect the current uncertainty about the benefits of treatment, which arise from the current lack of evidence from adequately powered clinical trials.
|
| first_indexed | 2024-04-13T03:49:48Z |
| format | Article |
| id | doaj.art-39a2917e8eda41208bb587d20e26ea9e |
| institution | Directory Open Access Journal |
| issn | 1424-3997 |
| language | English |
| last_indexed | 2024-04-13T03:49:48Z |
| publishDate | 2015-07-01 |
| publisher | SMW supporting association (Trägerverein Swiss Medical Weekly SMW) |
| record_format | Article |
| series | Swiss Medical Weekly |
| spelling | doaj.art-39a2917e8eda41208bb587d20e26ea9e2022-12-22T03:03:51ZengSMW supporting association (Trägerverein Swiss Medical Weekly SMW)Swiss Medical Weekly1424-39972015-07-01145313210.4414/smw.2015.14156Variation in treatment strategies of Swiss general practitioners for subclinical hypothyroidism in older adultsChristine BaumgartnerWendy P. J. den ElzenManuel R. BlumMichael CoslovskySven StreitPeter FreyLilli HerzigDagmar M. HallerSimon P. MooijaartThomas BischoffThomas RosemannJacobijn GusseklooNicolas Rodondi QUESTIONS UNDER STUDY: As the best management of subclinical hypothyroidism is controversial, we aimed to assess variations in treatment strategies depending on different Swiss regions, physician and patient characteristics. METHODS: We performed a case-based survey among general practitioners (GPs) in different Swiss regions, which consisted of eight hypothetical cases presenting a female patient with subclinical hypothyroidism and nonspecific complaints differing by age, vitality status and thyroid-stimulating hormone (TSH) concentration. RESULTS: A total of 262 GPs participated in the survey. There was considerable variation in the levothyroxine starting dose chosen by GPs, ranging from 25 µg to 100 µg. Across the Swiss regions, GPs in the Bern region were significantly more inclined to treat, with a higher probability of initiating treatment (60%, p = 0.01) and higher mean starting doses (45 µg, p <0.01) compared with the French-speaking region (44%, 36 µg); the Zurich region had intermediate values (52%, 39 µg). We found no association between treatment rate and other physician characteristics. GPs were more reluctant to initiate treatment in 85-year-old than in 70-year-old women (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.63–0.94), and more likely to treat women with a TSH of 15 mU/l than those with a TSH of 6mU/l (OR 8.71, 95% CI 6.21–12.20). CONCLUSIONS: There are strong variations in treatment strategies for elderly patients with subclinical hypothyroidism across different Swiss regions, including use of higher starting doses than the recommended 25 µg in the Swiss guidelines, which recommend a starting dose of 25 µg. These variations likely reflect the current uncertainty about the benefits of treatment, which arise from the current lack of evidence from adequately powered clinical trials. https://www.smw.ch/index.php/smw/article/view/2052general practicesurveysubclinical hypothyroidism |
| spellingShingle | Christine Baumgartner Wendy P. J. den Elzen Manuel R. Blum Michael Coslovsky Sven Streit Peter Frey Lilli Herzig Dagmar M. Haller Simon P. Mooijaart Thomas Bischoff Thomas Rosemann Jacobijn Gussekloo Nicolas Rodondi Variation in treatment strategies of Swiss general practitioners for subclinical hypothyroidism in older adults Swiss Medical Weekly general practice survey subclinical hypothyroidism |
| title | Variation in treatment strategies of Swiss general practitioners for subclinical hypothyroidism in older adults |
| title_full | Variation in treatment strategies of Swiss general practitioners for subclinical hypothyroidism in older adults |
| title_fullStr | Variation in treatment strategies of Swiss general practitioners for subclinical hypothyroidism in older adults |
| title_full_unstemmed | Variation in treatment strategies of Swiss general practitioners for subclinical hypothyroidism in older adults |
| title_short | Variation in treatment strategies of Swiss general practitioners for subclinical hypothyroidism in older adults |
| title_sort | variation in treatment strategies of swiss general practitioners for subclinical hypothyroidism in older adults |
| topic | general practice survey subclinical hypothyroidism |
| url | https://www.smw.ch/index.php/smw/article/view/2052 |
| work_keys_str_mv | AT christinebaumgartner variationintreatmentstrategiesofswissgeneralpractitionersforsubclinicalhypothyroidisminolderadults AT wendypjdenelzen variationintreatmentstrategiesofswissgeneralpractitionersforsubclinicalhypothyroidisminolderadults AT manuelrblum variationintreatmentstrategiesofswissgeneralpractitionersforsubclinicalhypothyroidisminolderadults AT michaelcoslovsky variationintreatmentstrategiesofswissgeneralpractitionersforsubclinicalhypothyroidisminolderadults AT svenstreit variationintreatmentstrategiesofswissgeneralpractitionersforsubclinicalhypothyroidisminolderadults AT peterfrey variationintreatmentstrategiesofswissgeneralpractitionersforsubclinicalhypothyroidisminolderadults AT lilliherzig variationintreatmentstrategiesofswissgeneralpractitionersforsubclinicalhypothyroidisminolderadults AT dagmarmhaller variationintreatmentstrategiesofswissgeneralpractitionersforsubclinicalhypothyroidisminolderadults AT simonpmooijaart variationintreatmentstrategiesofswissgeneralpractitionersforsubclinicalhypothyroidisminolderadults AT thomasbischoff variationintreatmentstrategiesofswissgeneralpractitionersforsubclinicalhypothyroidisminolderadults AT thomasrosemann variationintreatmentstrategiesofswissgeneralpractitionersforsubclinicalhypothyroidisminolderadults AT jacobijngussekloo variationintreatmentstrategiesofswissgeneralpractitionersforsubclinicalhypothyroidisminolderadults AT nicolasrodondi variationintreatmentstrategiesofswissgeneralpractitionersforsubclinicalhypothyroidisminolderadults |