title: Why are GPs treating subclinical hypothyroidism? Case note review and GP survey.
abstract: BACKGROUND
  Subclinical hypothyroidism (SCHo) is a common biochemical diagnosis in older age. Evidence of impact is inconclusive and guidelines are inconsistent. With increasing numbers of thyroid function tests (TFTs) performed, GPs frequently have to make management decisions regarding this diagnosis. However, little is known about how SCHo is currently being managed in primary care.
  
  
  OBJECTIVE
  To explore management of SCHo in primary care and GP reported rationale for treatment of SCHo in older individuals.
  
  
  METHODS
  Descriptive study using retrospective case note review and GP survey.
  
  
  METHODS
  Nineteen General Practices, Central England, UK.
  
  
  METHODS
  Follow-up of a large cohort with subsequent detailed review of individuals for whom therapy had been initiated following diagnosis of SCHo. Data on practice policies, and rationale behind treatment were collected via GP questionnaire.
  
  
  RESULTS
  Forty-two individuals were treated following identification of SCHo. Factors regarded as supporting instigation of therapy recorded by practitioners included symptoms, a positive antithyroid antibody test and history of radioiodine therapy. In all, 55% were registered at 3/19 practices suggesting significant between practice variation. Reasons for testing included chronic disease check-up (n = 14), presenting 'thyroid symptoms' (n = 5) and presenting other symptoms (n = 9). Reasons for therapy initiation were only recorded in 26 cases and included presence of symptoms, persistently high or increasing serum thyroid stimulating hormone concentration and patient request. Only 2/15 GPs reported having practice guidelines on management.
  
  
  CONCLUSIONS
  Results suggest that GPs are uncertain how to interpret symptoms and TFT results in older individuals. There is considerable variation in management of SCHo between GPs with some GPs treating patients outside of all guideline recommendations.
authors.affiliation: Care of Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, UK.
authors.forename: Jack
authors.initials: J
authors.lastname: Allport
authors.forename: Deborah
authors.initials: D
authors.lastname: McCahon
authors.forename: F D Richard
authors.initials: FD
authors.lastname: Hobbs
authors.forename: Lesley M
authors.initials: LM
authors.lastname: Roberts
mesh_terms: D017677:Age Distribution; D000368:Aged; D004739:England; D058006:General Practice / Q000379:methods* / Q000592:standards; D006801:Humans; D007037:Hypothyroidism / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D008499:Medical Records; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012189:Retrospective Studies; D013960:Thyroid Function Tests / Q000706:statistics & numerical data; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood
chemical_list: D013972:Thyrotropin; D013974:Thyroxine