den Elzen, WPJ,Lefebre-van de Fliert, AA,Virgini, V,Mooijaart, SP,Frey, P,Kearney, PM,Kerse, N,Mallen, CD,McCarthy, VJC,Muth, C,Rosemann, T,Russell, A,Schers, H,Stott, DJ,de Waal, MWM,Warner, A,Westendorp, RGJ,Rodondi, N,Gussekloo, J

2015

February

British Journal of General Practice

International variation in GP treatment strategies for subclinical hypothyroidism in older adults: a case-based survey

Validated

WOS: 10 ()

general practice subclinical hypothyroidism survey THYROID-DISEASE HEALTH DYSFUNCTION MANAGEMENT RISK

65

121

132

BackgroundThere is limited evidence about the impact of treatment for subclinical hypothyroidism, especially among older people.AimTo investigate the variation in GP treatment strategies for older patients with subclinical hypothyroidism depending on country and patient characteristics.Design and settingCase-based survey of GPs in the Netherlands, Germany, England, Ireland, Switzerland, and New Zealand.MethodThe 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 thyroidstimulating hormone (TSH) concentration (6 versus 15 mU/L).ResultsA 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]).ConclusionGP 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

10.3399/bjgp15X683569