title: Thyroid hormone replacement in women of reproductive age: is surgeon knowledge related to operative volume?
abstract: BACKGROUND
  It is not known if surgeons who place women of reproductive age on thyroid hormone replacement (levothyroxine, LT4) routinely inform them of the increased LT4 demands with future pregnancy. In addition, it is not clear whether reading the 2007 Endocrine Society's "Guidelines on the Management of Thyroid Dysfunction during Pregnancy and Postpartum" influences the role of the surgeon in patient education. The objective of this study was to identify the role of the surgeon in patient education at the time of initiation of LT4 therapy.
  
  
  METHODS
  A two-sided one-page survey was distributed to the 260 surgeons attending the 2009 American Association of Endocrine Surgeons' meeting. Of those distributed, 109 (42%) surgeons returned the survey.
  
  
  RESULTS
  Although only 26/109 (23%) read the 2007 Endocrine Society's "Guidelines on the Management of Thyroid Dysfunction during Pregnancy and Postpartum," reading the guidelines was associated with a significantly greater likelihood of informing patients of higher LT4 requirements with pregnancy (p < 0.0001). Eighty-five percent of those who read the guidelines "often" or "always" informed patients of higher LT4 requirements with future pregnancy, whereas only 44% of those who did not read the guidelines provided the same level of education. After controlling for surgeon sex, academic versus private practice, years in practice, and number of surgeries performed in 2008, the only independent predictor of patient education was reading the guidelines (p = 0.006). On multivariable analysis, surgeon volume was associated with reading the guidelines (p = 0.006). The mean number of thyroid surgeries performed by those who read the guidelines versus those who did not was 164.46 +/- 16.98 versus 115.01 +/- 8.27 (p = 0.005).
  
  
  CONCLUSIONS
  Surgeons who read the Endocrine Society's "Guidelines on the Management of Thyroid Dysfunction during Pregnancy and Postpartum" were significantly more likely to inform patients of the need for higher LT4 doses with pregnancy. Thyroid surgery volume was associated with guideline awareness.
authors.affiliation: Division of Metabolism, Endocrinology, and Diabetes, Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan 48109, USA. meganhay@med.umich.edu
authors.forename: Megan R
authors.initials: MR
authors.lastname: Haymart
authors.forename: Max A
authors.initials: MA
authors.lastname: Cayo
authors.forename: Herbert
authors.initials: H
authors.lastname: Chen
mesh_terms: D013507:Endocrine Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D007037:Hypothyroidism / Q000188:drug therapy; D008297:Male; D010353:Patient Education as Topic; D010820:Physicians; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D013959:Thyroid Diseases / Q000188:drug therapy*; D013961:Thyroid Gland / Q000502:physiology / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000601:surgery; D013974:Thyroxine / Q000627:therapeutic use*
chemical_list: D013974:Thyroxine
references.citation: Ann Surg. 1998 Sep;228(3):320-30
references.pmid: 9742915
references.citation: J Med Screen. 2000;7(3):127-30
references.pmid: 11126160
references.citation: Arch Otolaryngol Head Neck Surg. 2008 Oct;134(10):1076-9
references.pmid: 18936354
references.citation: Surgery. 2009 Oct;146(4):554-8; discussion 558-60
references.pmid: 19789012
references.citation: World J Surg. 2005 Oct;29(10):1217-21
references.pmid: 16132399
references.citation: J Matern Fetal Neonatal Med. 2006 Oct;19(10):651-4
references.pmid: 17118740
references.citation: Thyroid. 2009 Mar;19(3):269-75
references.pmid: 19265498
references.citation: Cancer. 2007 May 1;109(9):1715-20
references.pmid: 17387715
references.citation: Thyroid. 2010 Mar;20(3):301-7
references.pmid: 20146654
references.citation: N Engl J Med. 2003 Nov 27;349(22):2117-27
references.pmid: 14645640
references.citation: Clin Otolaryngol. 2008 Dec;33(6):587-91
references.pmid: 19126134
references.citation: Clin Endocrinol (Oxf). 2009 May;70(5):798-802
references.pmid: 18771569
references.citation: Am J Surg. 2005 May;189(5):587-91; discussion 591
references.pmid: 15862501
references.citation: J Clin Endocrinol Metab. 2007 Aug;92(8 Suppl):S1-47
references.pmid: 17948378
references.citation: J Clin Endocrinol Metab. 2009 Jan;94(1):21-5
references.pmid: 18984665
references.citation: N Engl J Med. 1990 Jul 12;323(2):91-6
references.pmid: 2359428
references.citation: Clin Endocrinol (Oxf). 2005 Nov;63(5):560-5
references.pmid: 16268809
references.citation: Surgery. 2000 Dec;128(6):994-8
references.pmid: 11114634
references.citation: Int J Fertil. 1990 Mar-Apr;35(2):75, 79-80, 81-94
references.pmid: 1970983
references.citation: N Engl J Med. 2004 Jul 15;351(3):241-9
references.pmid: 15254282
references.citation: N Engl J Med. 1999 Aug 19;341(8):549-55
references.pmid: 10451459
references.citation: Thyroid. 2009 Apr;19(4):391-4
references.pmid: 19207005
references.citation: J Clin Endocrinol Metab. 1990 Aug;71(2):276-87
references.pmid: 2116437
references.citation: J Clin Endocrinol Metab. 1998 Aug;83(8):2658-65
references.pmid: 9709928
references.citation: Surgery. 2007 Dec;142(6):876-83
references.pmid: 18063071
references.citation: Eur J Endocrinol. 2009 Jun;160(6):985-91
references.pmid: 19273570