Megan R Haymart1, Max A Cayo, Herbert Chen. 1. Division of Metabolism, Endocrinology, and Diabetes, Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan 48109, USA. meganhay@med.umich.edu
Abstract
BACKGROUND: It is not known if surgeons who place women of reproductive age on thyroid hormone replacement (levothyroxine, LT4) routinely inform them of the increased LT4 demands with future pregnancy. In addition, it is not clear whether reading the 2007 Endocrine Society's "Guidelines on the Management of Thyroid Dysfunction during Pregnancy and Postpartum" influences the role of the surgeon in patient education. The objective of this study was to identify the role of the surgeon in patient education at the time of initiation of LT4 therapy. METHODS: A two-sided one-page survey was distributed to the 260 surgeons attending the 2009 American Association of Endocrine Surgeons' meeting. Of those distributed, 109 (42%) surgeons returned the survey. RESULTS: Although only 26/109 (23%) read the 2007 Endocrine Society's "Guidelines on the Management of Thyroid Dysfunction during Pregnancy and Postpartum," reading the guidelines was associated with a significantly greater likelihood of informing patients of higher LT4 requirements with pregnancy (p < 0.0001). Eighty-five percent of those who read the guidelines "often" or "always" informed patients of higher LT4 requirements with future pregnancy, whereas only 44% of those who did not read the guidelines provided the same level of education. After controlling for surgeon sex, academic versus private practice, years in practice, and number of surgeries performed in 2008, the only independent predictor of patient education was reading the guidelines (p = 0.006). On multivariable analysis, surgeon volume was associated with reading the guidelines (p = 0.006). The mean number of thyroid surgeries performed by those who read the guidelines versus those who did not was 164.46 +/- 16.98 versus 115.01 +/- 8.27 (p = 0.005). CONCLUSION: Surgeons who read the Endocrine Society's "Guidelines on the Management of Thyroid Dysfunction during Pregnancy and Postpartum" were significantly more likely to inform patients of the need for higher LT4 doses with pregnancy. Thyroid surgery volume was associated with guideline awareness.
BACKGROUND: It is not known if surgeons who place women of reproductive age on thyroid hormone replacement (levothyroxine, LT4) routinely inform them of the increased LT4 demands with future pregnancy. In addition, it is not clear whether reading the 2007 Endocrine Society's "Guidelines on the Management of Thyroid Dysfunction during Pregnancy and Postpartum" influences the role of the surgeon in patient education. The objective of this study was to identify the role of the surgeon in patient education at the time of initiation of LT4 therapy. METHODS: A two-sided one-page survey was distributed to the 260 surgeons attending the 2009 American Association of Endocrine Surgeons' meeting. Of those distributed, 109 (42%) surgeons returned the survey. RESULTS: Although only 26/109 (23%) read the 2007 Endocrine Society's "Guidelines on the Management of Thyroid Dysfunction during Pregnancy and Postpartum," reading the guidelines was associated with a significantly greater likelihood of informing patients of higher LT4 requirements with pregnancy (p < 0.0001). Eighty-five percent of those who read the guidelines "often" or "always" informed patients of higher LT4 requirements with future pregnancy, whereas only 44% of those who did not read the guidelines provided the same level of education. After controlling for surgeon sex, academic versus private practice, years in practice, and number of surgeries performed in 2008, the only independent predictor of patient education was reading the guidelines (p = 0.006). On multivariable analysis, surgeon volume was associated with reading the guidelines (p = 0.006). The mean number of thyroid surgeries performed by those who read the guidelines versus those who did not was 164.46 +/- 16.98 versus 115.01 +/- 8.27 (p = 0.005). CONCLUSION: Surgeons who read the Endocrine Society's "Guidelines on the Management of Thyroid Dysfunction during Pregnancy and Postpartum" were significantly more likely to inform patients of the need for higher LT4 doses with pregnancy. Thyroid surgery volume was associated with guideline awareness.
Authors: Julie Ann Sosa; Tracy S Wang; Heather L Yeo; Pritesh J Mehta; Leon Boudourakis; Robert Udelsman; Sanziana A Roman Journal: Surgery Date: 2007-10-29 Impact factor: 3.982
Authors: J E Haddow; G E Palomaki; W C Allan; J R Williams; G J Knight; J Gagnon; C E O'Heir; M L Mitchell; R J Hermos; S E Waisbren; J D Faix; R Z Klein Journal: N Engl J Med Date: 1999-08-19 Impact factor: 91.245
Authors: Hannah G Piper; Samuel P Bugis; Graeme E Wilkins; Blair A M Walker; Sam Wiseman; Christopher R Baliski Journal: Am J Surg Date: 2005-05 Impact factor: 2.565
Authors: Marcos Abalovich; Nobuyuki Amino; Linda A Barbour; Rhoda H Cobin; Leslie J De Groot; Daniel Glinoer; Susan J Mandel; Alex Stagnaro-Green Journal: J Clin Endocrinol Metab Date: 2007-08 Impact factor: 5.958