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

Wendy P J den Elzen; Anne A Lefèbre-van de Fliert; Vanessa Virgini; Simon P Mooijaart; Peter Frey; Patricia M Kearney; Ngaire Kerse; Christian D Mallen; Vera J C McCarthy; Christiane Muth; Thomas Rosemann; Audrey Russell; Henk Schers; David J Stott; Margot W M de Waal; Alex Warner; Rudi G J Westendorp; Nicolas Rodondi; Jacobijn Gussekloo

doi:10.3399/bjgp15x683569

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

Wendy P J den Elzen, Anne A Lefèbre-van de Fliert, Vanessa Virgini, Simon P Mooijaart, Peter Frey, Patricia M Kearney, Ngaire Kerse, Christian D Mallen, Vera J C McCarthy, Christiane Muth, Thomas Rosemann, Audrey Russell, Henk Schers, David J Stott, Margot W M de Waal, Alex Warner, Rudi G J Westendorp, Nicolas Rodondi, Jacobijn Gussekloo

13 Citationer (Scopus)

Abstract

BACKGROUND: There is limited evidence about the impact of treatment for subclinical hypothyroidism, especially among older people.

AIM: To investigate the variation in GP treatment strategies for older patients with subclinical hypothyroidism depending on country and patient characteristics.

DESIGN AND SETTING: Case-based survey of GPs in the Netherlands, Germany, England, Ireland, Switzerland, and New Zealand.

METHOD: The 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 thyroid-stimulating hormone (TSH) concentration (6 versus 15 mU/L).

RESULTS: A 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]).

CONCLUSION: GP 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 care.

Originalsprog	Engelsk
Tidsskrift	British Journal of General Practice
Vol/bind	65
Udgave nummer	631
Sider (fra-til)	e121-132
Antal sider	12
ISSN	0960-1643
DOI	https://doi.org/10.3399/bjgp15x683569
Status	Udgivet - 1 feb. 2015
Udgivet eksternt	Ja

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10.3399/bjgp15x683569

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Citationsformater

den Elzen, W. P. J., Lefèbre-van de Fliert, A. A., Virgini, V., Mooijaart, S. P., Frey, P., Kearney, P. M., Kerse, N., Mallen, C. D., McCarthy, V. J. C., Muth, C., Rosemann, T., Russell, A., Schers, H., Stott, D. J., de Waal, M. W. M., Warner, A., Westendorp, R. G. J., Rodondi, N., & Gussekloo, J. (2015). International variation in GP treatment strategies for subclinical hypothyroidism in older adults: a case-based survey. British Journal of General Practice, 65(631), e121-132. https://doi.org/10.3399/bjgp15x683569

den Elzen, WPJ, Lefèbre-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, 'International variation in GP treatment strategies for subclinical hypothyroidism in older adults: a case-based survey', British Journal of General Practice, bind 65, nr. 631, s. e121-132. https://doi.org/10.3399/bjgp15x683569

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

abstract = "BACKGROUND: There is limited evidence about the impact of treatment for subclinical hypothyroidism, especially among older people.AIM: To investigate the variation in GP treatment strategies for older patients with subclinical hypothyroidism depending on country and patient characteristics.DESIGN AND SETTING: Case-based survey of GPs in the Netherlands, Germany, England, Ireland, Switzerland, and New Zealand.METHOD: The 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 thyroid-stimulating hormone (TSH) concentration (6 versus 15 mU/L).RESULTS: A 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]).CONCLUSION: GP 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 care.",

author = "{den Elzen}, {Wendy P J} and {Lef{\`e}bre-van de Fliert}, {Anne A} and Vanessa Virgini and Mooijaart, {Simon P} and Peter Frey and Kearney, {Patricia M} and Ngaire Kerse and Mallen, {Christian D} and McCarthy, {Vera J C} and Christiane Muth and Thomas Rosemann and Audrey Russell and Henk Schers and Stott, {David J} and {de Waal}, {Margot W M} and Alex Warner and Westendorp, {Rudi G J} and Nicolas Rodondi and Jacobijn Gussekloo",

note = "{\textcopyright} British Journal of General Practice 2015.",

year = "2015",

month = feb,

day = "1",

doi = "10.3399/bjgp15x683569",

language = "English",

volume = "65",

pages = "e121--132",

journal = "British Journal of General Practice",

issn = "0960-1643",

publisher = "Royal College of General Practitioners",

number = "631",

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TY - JOUR

T1 - International variation in GP treatment strategies for subclinical hypothyroidism in older adults

T2 - a case-based survey

AU - den Elzen, Wendy P J

AU - Lefèbre-van de Fliert, Anne A

AU - Virgini, Vanessa

AU - Mooijaart, Simon P

AU - Frey, Peter

AU - Kearney, Patricia M

AU - Kerse, Ngaire

AU - Mallen, Christian D

AU - McCarthy, Vera J C

AU - Muth, Christiane

AU - Rosemann, Thomas

AU - Russell, Audrey

AU - Schers, Henk

AU - Stott, David J

AU - de Waal, Margot W M

AU - Warner, Alex

AU - Westendorp, Rudi G J

AU - Rodondi, Nicolas

AU - Gussekloo, Jacobijn

PY - 2015/2/1

Y1 - 2015/2/1

N2 - BACKGROUND: There is limited evidence about the impact of treatment for subclinical hypothyroidism, especially among older people.AIM: To investigate the variation in GP treatment strategies for older patients with subclinical hypothyroidism depending on country and patient characteristics.DESIGN AND SETTING: Case-based survey of GPs in the Netherlands, Germany, England, Ireland, Switzerland, and New Zealand.METHOD: The 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 thyroid-stimulating hormone (TSH) concentration (6 versus 15 mU/L).RESULTS: A 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]).CONCLUSION: GP 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 care.

AB - BACKGROUND: There is limited evidence about the impact of treatment for subclinical hypothyroidism, especially among older people.AIM: To investigate the variation in GP treatment strategies for older patients with subclinical hypothyroidism depending on country and patient characteristics.DESIGN AND SETTING: Case-based survey of GPs in the Netherlands, Germany, England, Ireland, Switzerland, and New Zealand.METHOD: The 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 thyroid-stimulating hormone (TSH) concentration (6 versus 15 mU/L).RESULTS: A 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]).CONCLUSION: GP 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 care.

U2 - 10.3399/bjgp15x683569

DO - 10.3399/bjgp15x683569

M3 - Journal article

C2 - 25624308

SN - 0960-1643

VL - 65

SP - e121-132

JO - British Journal of General Practice

JF - British Journal of General Practice

IS - 631

ER -

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

Abstract

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