The Impact of Age in the Management of Hypothyroidism: Results of a Nationwide Survey |
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| Affiliation: | 1. From the Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan.;2. Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.;1. Retrovirus Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy;2. ARPA Foundation, Pisa, Italy;3. North-Western Tuscany Blood Bank, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy;4. Transfusion Medicine and Transplant Biology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy;5. Center for Spinal Cord Injuries, Department of Neurosciences, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy;6. Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy;1. Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China;2. Heart of England National Health Service Foundation Trust, Bordesley Green, East Birmingham, UK;3. Guy''s and St Thomas'' Hospital National Health Service Foundation Trust, London, UK;4. Beijing Armed Police General Hospital, Beijing, China;5. Second Hospital of Lanzhou University, Lanzhou, China;6. Jing-Meng Stem Cell Company, Beijing, China;1. Veterinary Clinical Sciences, School of Veterinary Medicine, University College Dublin, Dublin, Ireland;2. Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands;3. Department of Internal Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands |
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| Abstract: | Objective: Evidence exists that thyroid-stimulating hormone (TSH) increases with age and lowering the TSH goal in older patients on thyroid hormone may cause over-treatment. Risks of overtreatment include cardiac and skeletal events. We assessed practice patterns regarding TSH goals and explored factors influencing physicians' decision making when managing hypothyroidism.Methods: Members of the American College of Physicians, the American Academy of Family Practice, and the Endocrine Society were surveyed to determine goal TSH when treating hypothyroidism.Results: Fifty-three percent of physicians reported factoring patient age into their decision making when managing hypothyroidism. Patient age was prioritized third (53%), following patient symptoms (69.2%) and cardiac arrhythmias (65.7%). In multivariable analysis, endocrinologists (P = .002), internists (P = .049), physicians in academic settings (P = .003), and high-volume physicians (P = .021) were more likely to consider patient age when determining goal TSH. When presented with scenarios differing in patient gender and age, 90% of physicians targeted a TSH ≤3.0 mIU/L in 30-year-old patients. Fifty-three percent of respondents targeted a TSH ≤3.0 mIU/L in octogenarians, but 90% targeted a TSH >1.5 mIU/L in this group. Regardless of gender, physician-reported TSH goal ranges (0.1 to 0.5, 0.6 to 1.5, 1.6 to 3.0, and 3.1 to 5.0 mIU/L) increased in a direct relationship to patient age (P<.001).Conclusion: Just over half of physicians consider patient age when determining TSH goal. When presented with scenarios differing in patient age and gender, physicians targeted a higher TSH goal in octogenarians. This may indicate an attempt to avoid overtreatment in this group. Consensus is needed among physicians regarding the role of patient age in hypothyroidism management.Abbreviations:TSH = thyroid-stimulating hormone |
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