Multinational Survey of Treatment Practices of Clinicians Managing Subclinical Hypothyroidism in Older People in 2019.
Multinational Survey of Treatment Practices of Clinicians Managing Subclinical Hypothyroidism in Older People in 2019.
复制标题
2019 年临床医生治疗老年人亚临床甲状腺功能减退症治疗实践的多国调查。
DOI：
10.1159/000509228
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发表时间：
2021
影响因子：
4.7
通讯作者：
Razvi S
中科院分区：
文献类型：
--
作者：
Razvi S
背景资料：国际协会建议，不应常规处方左旋甲状腺素用于老年人轻度亚临床甲状腺功能减退症（SCH）的管理。然而，尚不清楚管理SCH患者的临床医生是否意识到或遵守这些指南。方法：对英格兰东北部几个国际甲状腺协会和全科医生的成员进行了基于网络的调查。受访者被呈现一个小插曲的80岁的绅士与轻度持续SCH经历疲劳。进行多变量逻辑回归分析，以评估对指南的认识和对治疗的反应的预测因素。结果：调查应答率为21.9%（565/2,583）。只有7.6%的临床医生不知道关于老年人SCH管理的指南。20%的临床医生表示他们将用轻度SCH治疗老年患者，而13%的临床医生不确定。来自北美的临床医生比来自其他地方的临床医生更有可能治疗患有轻度SCH的老年人（OR 2.24 [1.25-3.98]）。同样，非内分泌科医生也比内分泌科医生更有可能治疗轻度SCH的老年人（OR 3.26 [1.45-6.47]）。结论：大多数临床医生都知道关于老年人SCH管理的指南。然而，相当大比例的临床医生仍然会治疗老年人的非特异性症状和轻度SCH。这些指南需要更广泛地传播，需要更多的研究来了解遵守international recommendations.AbstractBackground：国际社会建议，左旋甲状腺素不应常规规定在老年人轻度亚临床甲状腺功能减退症（SCH）的管理。然而，尚不清楚管理SCH患者的临床医生是否意识到或遵守这些指南。方法：对英格兰东北部几个国际甲状腺协会和全科医生的成员进行了基于网络的调查。受访者被呈现一个小插曲的80岁的绅士与轻度持续SCH经历疲劳。进行多变量逻辑回归分析，以评估对指南的认识和对治疗的反应的预测因素。结果：调查应答率为21.9%（565/2,583）。只有7.6%的临床医生不知道关于老年人SCH管理的指南。20%的临床医生表示他们将用轻度SCH治疗老年患者，而13%的临床医生不确定。来自北美的临床医生比来自其他地方的临床医生更有可能治疗患有轻度SCH的老年人（OR 2.24 [1.25-3.98]）。同样，非内分泌科医生也比内分泌科医生更有可能治疗轻度SCH的老年人（OR 3.26 [1.45-6.47]）。结论：大多数临床医生都知道关于老年人SCH管理的指南。然而，相当比例的临床医生仍然会治疗老年人的非特异性症状和轻度SCH。这些指南需要更广泛地传播，需要更多的研究，以了解遵守国际建议的障碍。
Background: International societies have recommended that levothyroxine should not routinely be prescribed in older individuals for the management of mild subclinical hypothyroidism (SCH). However, it is unknown whether clinicians managing people with SCH are either aware of or adhere to these guidelines. Methods: A web-based survey of members of several international thyroid associations and general practitioners in North-East England was conducted. Respondents were presented with a vignette of an 80-year-old gentleman with mild persistent SCH experiencing tiredness. Multivariable logistic regression analyses were performed to evaluate predictors of awareness of guidelines and responses to treatment. Results: The survey response rate was 21.9%(565/2,583). Only 7.6% of clinicians were unaware of guidelines regarding management of SCH in older people. Twenty percent of clinicians stated that they would treat the older patient with mild SCH, whereas 13% were unsure. Clinicians from North America were more likely to treat the older person with mild SCH than clinicians from elsewhere (OR 2.24 [1.25–3.98]). Likewise, non-endocrinologists were also more likely than endocrinologists to treat the older person with mild SCH (OR 3.26 [1.45–6.47]). Conclusion: The majority of clinicians are aware of guidelines regarding management of SCH in older individuals. However, a considerable proportion of clinicians would still treat an older person with non-specific symptoms and mild SCH. These guidelines need to be disseminated more widely and more research is required to understand barriers to adherence to international recommendations.AbstractBackground: International societies have recommended that levothyroxine should not routinely be prescribed in older individuals for the management of mild subclinical hypothyroidism (SCH). However, it is unknown whether clinicians managing people with SCH are either aware of or adhere to these guidelines. Methods: A web-based survey of members of several international thyroid associations and general practitioners in North-East England was conducted. Respondents were presented with a vignette of an 80-year-old gentleman with mild persistent SCH experiencing tiredness. Multivariable logistic regression analyses were performed to evaluate predictors of awareness of guidelines and responses to treatment. Results: The survey response rate was 21.9%(565/2,583). Only 7.6% of clinicians were unaware of guidelines regarding management of SCH in older people. Twenty percent of clinicians stated that they would treat the older patient with mild SCH, whereas 13% were unsure. Clinicians from North America were more likely to treat the older person with mild SCH than clinicians from elsewhere (OR 2.24 [1.25–3.98]). Likewise, non-endocrinologists were also more likely than endocrinologists to treat the older person with mild SCH (OR 3.26 [1.45–6.47]). Conclusion: The majority of clinicians are aware of guidelines regarding management of SCH in older individuals. However, a considerable proportion of clinicians would still treat an older person with non-specific symptoms and mild SCH. These guidelines need to be disseminated more widely and more research is required to understand barriers to adherence to international recommendations.