Treating subclinical hypothyroidism in individuals with or without mental health problems –A Delphi based expert consensus study in two countries
BackgroundSubclinical hypothyroidism (SCH) is a common endocrine problem with prevalence estimates between 4% and 20%. Symptoms are often non-specific but can substantially affect well-being leading to repeated medical consultations. The effect of thyroid hormone replacement therapy (THRT) in patien...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-07-01
|
| Series: | Frontiers in Endocrinology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2023.1204842/full |
| _version_ | 1827902983310934016 |
|---|---|
| author | Ingrid Lieber Christina Maria Van Der Feltz-Cornelis Christina Maria Van Der Feltz-Cornelis Christina Maria Van Der Feltz-Cornelis Christina Maria Van Der Feltz-Cornelis Christina Maria Van Der Feltz-Cornelis Salman Razvi Andrew S. Moriarty Andrew S. Moriarty Scott Wilkes Michael Ott Julie Mannchen Mats Eliasson Ursula Werneke |
| author_facet | Ingrid Lieber Christina Maria Van Der Feltz-Cornelis Christina Maria Van Der Feltz-Cornelis Christina Maria Van Der Feltz-Cornelis Christina Maria Van Der Feltz-Cornelis Christina Maria Van Der Feltz-Cornelis Salman Razvi Andrew S. Moriarty Andrew S. Moriarty Scott Wilkes Michael Ott Julie Mannchen Mats Eliasson Ursula Werneke |
| author_sort | Ingrid Lieber |
| collection | DOAJ |
| description | BackgroundSubclinical hypothyroidism (SCH) is a common endocrine problem with prevalence estimates between 4% and 20%. Symptoms are often non-specific but can substantially affect well-being leading to repeated medical consultations. The effect of thyroid hormone replacement therapy (THRT) in patients with SCH remains uncertain. Current guidelines, limited by the lack of high-quality evidence, have been controversial with limited adherence in clinical practice.MethodsThree-round modified Delphi method to establish consensus regarding diagnosis and treatment of individuals with SCH with and without affective disorder or anxiety, conducted with clinicians from three specialties, general practice, endocrinology and psychiatry, and two countries, Sweden and the United Kingdom.ResultsSixty clinicians, 20 per specialty, were recruited. Fifty-three (88%) participants completed all three rounds. The participants reached consensus on five of the 26 practice statements that (a) repeated testing was required for the diagnosis of subclinical hypothyroidism, (b) antibody screening should usually occur, and (c and d) antibody screening would strengthen the indication for thyroid hormone replacement therapy in both individuals with or without affective disorder or anxiety. The participants disagreed with (e) a requirement of a TSH threshold ≥ 20 mIU/L for thyroid hormone replacement therapy start. Psychiatrists and GPs but not endocrinologists, agreed that there was a frequent discrepancy between laboratory results and clinical symptoms, and disagreed that testing for thyroid dysfunction was overused in patients presenting with depression or anxiety, or fatigue.ConclusionsIn many aspects, attitudes toward diagnosing and treating SCH remain diverse. The inability of our Delphi panel to achieve consensus on most items and the disagreement with a TSH ≥ 20 mIU/L threshold for treatment suggest that the concept of SCH may need rethinking with a better understanding of the hypothalamic-pituitary-thyroid physiology. Given that the scientific evidence is currently not conclusive, guidelines in this area should not be taken as definitive. |
| first_indexed | 2024-03-13T00:06:52Z |
| format | Article |
| id | doaj.art-84c5b17854e8452eabd73fc59d89cd4b |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-03-13T00:06:52Z |
| publishDate | 2023-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-84c5b17854e8452eabd73fc59d89cd4b2023-07-13T00:32:20ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922023-07-011410.3389/fendo.2023.12048421204842Treating subclinical hypothyroidism in individuals with or without mental health problems –A Delphi based expert consensus study in two countriesIngrid Lieber0Christina Maria Van Der Feltz-Cornelis1Christina Maria Van Der Feltz-Cornelis2Christina Maria Van Der Feltz-Cornelis3Christina Maria Van Der Feltz-Cornelis4Christina Maria Van Der Feltz-Cornelis5Salman Razvi6Andrew S. Moriarty7Andrew S. Moriarty8Scott Wilkes9Michael Ott10Julie Mannchen11Mats Eliasson12Ursula Werneke13Department of Clinical Sciences, Division of Psychiatry, Sunderby Research Unit, Umeå University, Umeå, SwedenDepartment of Health Sciences, University of York, York, United KingdomHull York Medical School, University of York, York, United KingdomYork Biomedical Research Institute, University of York, York, United KingdomR&D Department, Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, United KingdomInstitute of Health Informatics, University College London, London, United KingdomTranslational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United KingdomDepartment of Health Sciences, University of York, York, United KingdomHull York Medical School, University of York, York, United KingdomFaculty of Health Sciences and Wellbeing, School of Medicine, University of Sunderland, Sunderland, United KingdomDepartment of Public Health and Clinical Medicine – Medicine, Umeå University, Umeå, Sweden0Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden1Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Luleå, SwedenDepartment of Clinical Sciences, Division of Psychiatry, Sunderby Research Unit, Umeå University, Umeå, SwedenBackgroundSubclinical hypothyroidism (SCH) is a common endocrine problem with prevalence estimates between 4% and 20%. Symptoms are often non-specific but can substantially affect well-being leading to repeated medical consultations. The effect of thyroid hormone replacement therapy (THRT) in patients with SCH remains uncertain. Current guidelines, limited by the lack of high-quality evidence, have been controversial with limited adherence in clinical practice.MethodsThree-round modified Delphi method to establish consensus regarding diagnosis and treatment of individuals with SCH with and without affective disorder or anxiety, conducted with clinicians from three specialties, general practice, endocrinology and psychiatry, and two countries, Sweden and the United Kingdom.ResultsSixty clinicians, 20 per specialty, were recruited. Fifty-three (88%) participants completed all three rounds. The participants reached consensus on five of the 26 practice statements that (a) repeated testing was required for the diagnosis of subclinical hypothyroidism, (b) antibody screening should usually occur, and (c and d) antibody screening would strengthen the indication for thyroid hormone replacement therapy in both individuals with or without affective disorder or anxiety. The participants disagreed with (e) a requirement of a TSH threshold ≥ 20 mIU/L for thyroid hormone replacement therapy start. Psychiatrists and GPs but not endocrinologists, agreed that there was a frequent discrepancy between laboratory results and clinical symptoms, and disagreed that testing for thyroid dysfunction was overused in patients presenting with depression or anxiety, or fatigue.ConclusionsIn many aspects, attitudes toward diagnosing and treating SCH remain diverse. The inability of our Delphi panel to achieve consensus on most items and the disagreement with a TSH ≥ 20 mIU/L threshold for treatment suggest that the concept of SCH may need rethinking with a better understanding of the hypothalamic-pituitary-thyroid physiology. Given that the scientific evidence is currently not conclusive, guidelines in this area should not be taken as definitive.https://www.frontiersin.org/articles/10.3389/fendo.2023.1204842/fullsubclinical hypothyroidismTSHaffective disorderDelphi methodconsensuspractice guideline |
| spellingShingle | Ingrid Lieber Christina Maria Van Der Feltz-Cornelis Christina Maria Van Der Feltz-Cornelis Christina Maria Van Der Feltz-Cornelis Christina Maria Van Der Feltz-Cornelis Christina Maria Van Der Feltz-Cornelis Salman Razvi Andrew S. Moriarty Andrew S. Moriarty Scott Wilkes Michael Ott Julie Mannchen Mats Eliasson Ursula Werneke Treating subclinical hypothyroidism in individuals with or without mental health problems –A Delphi based expert consensus study in two countries Frontiers in Endocrinology subclinical hypothyroidism TSH affective disorder Delphi method consensus practice guideline |
| title | Treating subclinical hypothyroidism in individuals with or without mental health problems –A Delphi based expert consensus study in two countries |
| title_full | Treating subclinical hypothyroidism in individuals with or without mental health problems –A Delphi based expert consensus study in two countries |
| title_fullStr | Treating subclinical hypothyroidism in individuals with or without mental health problems –A Delphi based expert consensus study in two countries |
| title_full_unstemmed | Treating subclinical hypothyroidism in individuals with or without mental health problems –A Delphi based expert consensus study in two countries |
| title_short | Treating subclinical hypothyroidism in individuals with or without mental health problems –A Delphi based expert consensus study in two countries |
| title_sort | treating subclinical hypothyroidism in individuals with or without mental health problems a delphi based expert consensus study in two countries |
| topic | subclinical hypothyroidism TSH affective disorder Delphi method consensus practice guideline |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2023.1204842/full |
| work_keys_str_mv | AT ingridlieber treatingsubclinicalhypothyroidisminindividualswithorwithoutmentalhealthproblemsadelphibasedexpertconsensusstudyintwocountries AT christinamariavanderfeltzcornelis treatingsubclinicalhypothyroidisminindividualswithorwithoutmentalhealthproblemsadelphibasedexpertconsensusstudyintwocountries AT christinamariavanderfeltzcornelis treatingsubclinicalhypothyroidisminindividualswithorwithoutmentalhealthproblemsadelphibasedexpertconsensusstudyintwocountries AT christinamariavanderfeltzcornelis treatingsubclinicalhypothyroidisminindividualswithorwithoutmentalhealthproblemsadelphibasedexpertconsensusstudyintwocountries AT christinamariavanderfeltzcornelis treatingsubclinicalhypothyroidisminindividualswithorwithoutmentalhealthproblemsadelphibasedexpertconsensusstudyintwocountries AT christinamariavanderfeltzcornelis treatingsubclinicalhypothyroidisminindividualswithorwithoutmentalhealthproblemsadelphibasedexpertconsensusstudyintwocountries AT salmanrazvi treatingsubclinicalhypothyroidisminindividualswithorwithoutmentalhealthproblemsadelphibasedexpertconsensusstudyintwocountries AT andrewsmoriarty treatingsubclinicalhypothyroidisminindividualswithorwithoutmentalhealthproblemsadelphibasedexpertconsensusstudyintwocountries AT andrewsmoriarty treatingsubclinicalhypothyroidisminindividualswithorwithoutmentalhealthproblemsadelphibasedexpertconsensusstudyintwocountries AT scottwilkes treatingsubclinicalhypothyroidisminindividualswithorwithoutmentalhealthproblemsadelphibasedexpertconsensusstudyintwocountries AT michaelott treatingsubclinicalhypothyroidisminindividualswithorwithoutmentalhealthproblemsadelphibasedexpertconsensusstudyintwocountries AT juliemannchen treatingsubclinicalhypothyroidisminindividualswithorwithoutmentalhealthproblemsadelphibasedexpertconsensusstudyintwocountries AT matseliasson treatingsubclinicalhypothyroidisminindividualswithorwithoutmentalhealthproblemsadelphibasedexpertconsensusstudyintwocountries AT ursulawerneke treatingsubclinicalhypothyroidisminindividualswithorwithoutmentalhealthproblemsadelphibasedexpertconsensusstudyintwocountries |