Treatment Discontinuation within 3 Years of Levothyroxine Initiation among Children Diagnosed with Congenital Hypothyroidism
Treatment Discontinuation within 3 Years of Levothyroxine Initiation among Children Diagnosed with Congenital Hypothyroidism
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DOI：
10.1016/j.jpeds.2020.05.005
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发表时间：
2020-08-01
影响因子：
5.1
通讯作者：
Shapira, Stuart K.
中科院分区：
文献类型：
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作者：
Kemper, Alex R.;Grosse, Scott D.;Shapira, Stuart K.
目的测量先天性甲状腺功能减退症患者甲状腺显像和左旋甲状腺素(L-T4)停药的发生率，并评估促甲状腺激素试验是否监测停药情况。研究设计对2010年至2016年期间出生、连续参加非资本性雇主赞助的私人医疗保险计划或自L-T-4处方填写之日起连续参加联邦医疗补助的儿童的索赔数据进行回顾性分析。结果符合纳入标准的有263名私人保险儿童和241名参加医疗补助的儿童。与参加医疗补助的儿童相比，更多的私人保险儿童在第一次填写处方到最后一次填写处方后180天之间进行成像(24.3%对12.9%；P=.001)。到36个月时，35.7%的患者停止使用L-T-4，保险状况没有差异(P=0.48)。在停止服药的儿童中，29.1%的私人参保儿童和47.7%的参加医疗补助的儿童在接下来的180天内没有要求进行促甲状腺激素检测(P=0.01)。结论近三分之一的疑似先天性甲状腺功能减退症儿童在3年内停止使用L-T-4，参加医疗补助的儿童接受及时随访促甲状腺激素检测的人数少于参加医疗补助的儿童。未来的研究表明，要了解先天性甲状腺功能减退症儿童的护理质量和发育结果，以及在评估暂时性先天性甲状腺功能减退症时遵守指南的障碍。
Objectives To measure the rates of thyroid gland imaging and levothyroxine (L-T4) discontinuation and to assess whether discontinuation was monitored with thyroid-stimulating hormone testing in subjects with congenital hypothyroidism.Study design This is a retrospective analysis of claims data from the IBM MarketScan Databases for children born between 2010 and 2016 and continuously enrolled in a noncapitated employer-sponsored private health insurance plan or in Medicaid for >= 36 months from the date of the first filled L-T-4 prescription.Results There were 263 privately insured and 241 Medicaid-enrolled children who met the inclusion criteria. More privately insured than Medicaid-enrolled children had imaging between the first filled prescription and 180 days after the last filled prescription (24.3% vs 12.9%; P = .001). By 36 months, 35.7% discontinued L-T-4, with no difference by insurance status (P = .48). Among those who discontinued, 29.1% of privately insured children and 47.7% of Medicaid-enrolled children had no claims for thyroid-stimulating hormone testing within the next 180 days (P = .01).Conclusions Nearly one-third of children with suspected congenital hypothyroidism discontinued L-T-4 by 3 years and fewer Medicaid-enrolled than privately insured children received timely follow-up thyroid-stimulating hormone testing. Future studies are indicated to understand the quality of care and developmental outcomes for children with congenital hypothyroidism and barriers to guideline adherence in evaluating for transient congenital hypothyroidism.