Variation in treatment strategies of Swiss general practitioners for subclinical hypothyroidism in older adults.

Détails

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Etat: Serval
Version: Final published version
ID Serval
serval:BIB_C0F4BD6DDC35
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Variation in treatment strategies of Swiss general practitioners for subclinical hypothyroidism in older adults.
Périodique
Swiss Medical Weekly
Auteur(s)
Baumgartner C., den Elzen W.P., Blum M.R., Coslovsky M., Streit S., Frey P., Herzig L., Haller D.M., Mooijaart S.P., Bischoff T., Rosemann T., Gussekloo J., Rodondi N.
ISSN
1424-3997 (Electronic)
ISSN-L
0036-7672
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
145
Pages
w14156
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Résumé
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.
Mots-clé
Age Factors, Aged, Aged, 80 and over, Female, General Practitioners/statistics & numerical data, Hormone Replacement Therapy/methods, Humans, Hypothyroidism/blood, Hypothyroidism/drug therapy, Male, Practice Patterns, Physicians'/statistics & numerical data, Sex Factors, Switzerland, Thyrotropin/blood, Thyroxine/administration & dosage
Pubmed
Open Access
Oui
Création de la notice
02/02/2016 12:42
Dernière modification de la notice
09/05/2019 0:44
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