title: Management practices among primary care physicians and thyroid specialists in the care of hypothyroid patients.
abstract: Prospective studies are not available to address various issues commonly encountered in the management of hypothyroid patients. We have conducted a case-based mail survey of American Thyroid Association (ATA) members and primary care providers (PCP) regarding hypothyroidism management issues. A majority of ATA members and a minority of PCPs used antithyroid antibody testing in the evaluation of hypothyroidism. Approximately 2/3 of all respondents indicated that they would treat patients with mild thyroid failure when antithyroid antibodies are negative; 77% of PCPs and 95% of ATA members recommended treatment when antibodies are positive. For a young patient with mild thyroid failure, 71% of ATA members would initiate a full levothyroxine (LT4) replacement dose of 1.6 microg/kg per day or slightly lower; PCPs were more likely to start with a low dose and titrate upwards. For a young patient with overt hypothyroidism, 42% of PCPs and 51% of ATA respondents recommended an initial full LT4 replacement dose. The majority of all respondents would start with a low LT4 dose and adjust the dose gradually in an elderly patient, regardless of the severity of thyroid hormone deficiency. More than 40% of ATA respondents chose a target thyrotropin (TSH) range of 0.5-2.0 microU/mL for a young patient while 39% favored a goal of 1.0-4.0 microU/mL for an elderly patient. PCPs more often chose a broader TSH goal of 0.5-5.0 microU/mL. In conclusion, the current practice patterns of PCPs and ATA members that were elicited in this survey differ significantly in regard to the evaluation and management of hypothyroidism.
authors.affiliation: Division of Endocrinology, Metabolism & Diabetes, University of Colorado Health Sciences Center, Denver 80262, USA. michael.mcdermott@uchsc.edu
authors.forename: M T
authors.initials: MT
authors.lastname: McDermott
authors.forename: B R
authors.initials: BR
authors.lastname: Haugen
authors.forename: D C
authors.initials: DC
authors.lastname: Lezotte
authors.forename: S
authors.initials: S
authors.lastname: Seggelke
authors.forename: E C
authors.initials: EC
authors.lastname: Ridgway
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000032:analysis; D003625:Data Collection; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy*; D008297:Male; D008511:Medicine / Q000379:methods*; D008875:Middle Aged; D010346:Patient Care Management / Q000379:methods*; D011320:Primary Health Care; D013038:Specialization; D013961:Thyroid Gland / Q000276:immunology; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D001323:Autoantibodies; D013972:Thyrotropin; D013974:Thyroxine