Salman Razvi1, Bronia Arnott2, Dawn Teare2, Shaun Hiu2, Nicki O'Brien3, Simon H Pearce1. 1. Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom. 2. Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom. 3. Department of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom.
Abstract
BACKGROUND: International societies have recommended that levothyroxine should not routinely be prescribed in older individuals for the management of mild subclinical hypothyroidism (SCH). However, it is unknown whether clinicians managing people with SCH are either aware of or adhere to these guidelines. METHODS: A web-based survey of members of several international thyroid associations and general practitioners in North-East England was conducted. Respondents were presented with a vignette of an 80-year-old gentleman with mild persistent SCH experiencing tiredness. Multivariable logistic regression analyses were performed to evaluate predictors of awareness of guidelines and responses to treatment. RESULTS: The survey response rate was 21.9% (565/2,583). Only 7.6% of clinicians were unaware of guidelines regarding management of SCH in older people. Twenty percent of clinicians stated that they would treat the older patient with mild SCH, whereas 13% were unsure. Clinicians from North America were more likely to treat the older person with mild SCH than clinicians from elsewhere (OR 2.24 [1.25-3.98]). Likewise, non-endocrinologists were also more likely than endocrinologists to treat the older person with mild SCH (OR 3.26 [1.45-6.47]). CONCLUSION: The majority of clinicians are aware of guidelines regarding management of SCH in older individuals. However, a considerable proportion of clinicians would still treat an older person with non-specific symptoms and mild SCH. These guidelines need to be disseminated more widely and more research is required to understand barriers to adherence to international recommendations.
BACKGROUND: International societies have recommended that levothyroxine should not routinely be prescribed in older individuals for the management of mild subclinical hypothyroidism (SCH). However, it is unknown whether clinicians managing people with SCH are either aware of or adhere to these guidelines. METHODS: A web-based survey of members of several international thyroid associations and general practitioners in North-East England was conducted. Respondents were presented with a vignette of an 80-year-old gentleman with mild persistent SCH experiencing tiredness. Multivariable logistic regression analyses were performed to evaluate predictors of awareness of guidelines and responses to treatment. RESULTS: The survey response rate was 21.9% (565/2,583). Only 7.6% of clinicians were unaware of guidelines regarding management of SCH in older people. Twenty percent of clinicians stated that they would treat the older patient with mild SCH, whereas 13% were unsure. Clinicians from North America were more likely to treat the older person with mild SCH than clinicians from elsewhere (OR 2.24 [1.25-3.98]). Likewise, non-endocrinologists were also more likely than endocrinologists to treat the older person with mild SCH (OR 3.26 [1.45-6.47]). CONCLUSION: The majority of clinicians are aware of guidelines regarding management of SCH in older individuals. However, a considerable proportion of clinicians would still treat an older person with non-specific symptoms and mild SCH. These guidelines need to be disseminated more widely and more research is required to understand barriers to adherence to international recommendations.
Authors: Avantika C Waring; Alice M Arnold; Anne B Newman; Petra Bùzková; Calvin Hirsch; Anne R Cappola Journal: J Clin Endocrinol Metab Date: 2012-08-09 Impact factor: 5.958
Authors: Henry B Burch; Kenneth D Burman; David S Cooper; James V Hennessey; Nicole O Vietor Journal: J Clin Endocrinol Metab Date: 2016-03-25 Impact factor: 5.958
Authors: Gabriela Brenta; Mario Vaisman; José Augusto Sgarbi; Liliana Maria Bergoglio; Nathalia Carvalho de Andrada; Pedro Pineda Bravo; Ana Maria Orlandi; Hans Graf Journal: Arq Bras Endocrinol Metabol Date: 2013-06
Authors: Anna M Sawka; Anne R Cappola; Robin P Peeters; Peter A Kopp; Antonio C Bianco; Jacqueline Jonklaas Journal: Thyroid Date: 2019-10-03 Impact factor: 6.568
Authors: Simon H S Pearce; Georg Brabant; Leonidas H Duntas; Fabio Monzani; Robin P Peeters; Salman Razvi; Jean-Louis Wemeau Journal: Eur Thyroid J Date: 2013-11-27
Authors: Marci R Turner; Ximena Camacho; Hadas D Fischer; Peter C Austin; Geoff M Anderson; Paula A Rochon; Lorraine L Lipscombe Journal: BMJ Date: 2011-04-28
Authors: S W Jansen; A A Akintola; F Roelfsema; E van der Spoel; C M Cobbaert; B E Ballieux; P Egri; Z Kvarta-Papp; B Gereben; C Fekete; P E Slagboom; J van der Grond; B A Demeneix; H Pijl; R G J Westendorp; D van Heemst Journal: Sci Rep Date: 2015-06-19 Impact factor: 4.379
Authors: Graziano Ceresini; Gian Paolo Ceda; Fulvio Lauretani; Marcello Maggio; Elisa Usberti; Michela Marina; Stefania Bandinelli; Jack M Guralnik; Giorgio Valenti; Luigi Ferrucci Journal: J Am Geriatr Soc Date: 2013-05-06 Impact factor: 7.538