International variation in GP treatment strategies for subclinical hypothyroidism in older adults: a case-based survey
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International variation in GP treatment strategies for subclinical hypothyroidism in older adults : a case-based survey. / den Elzen, Wendy P J; Lefèbre-van de Fliert, Anne A; Virgini, Vanessa; Mooijaart, Simon P; Frey, Peter; Kearney, Patricia M; Kerse, Ngaire; Mallen, Christian D; McCarthy, Vera J C; Muth, Christiane; Rosemann, Thomas; Russell, Audrey; Schers, Henk; Stott, David J; de Waal, Margot W M; Warner, Alex; Westendorp, Rudi G J; Rodondi, Nicolas; Gussekloo, Jacobijn.
In: British Journal of General Practice, Vol. 65, No. 631, 02.2015, p. e121-132.Research output: Contribution to journal › Journal article › Research › peer-review
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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
N1 - © British Journal of General Practice 2015.
PY - 2015/2
Y1 - 2015/2
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
VL - 65
SP - e121-132
JO - British Journal of General Practice
JF - British Journal of General Practice
SN - 0960-1643
IS - 631
ER -
ID: 140396029