Changes in Prescription Routines for Treating Hypothyroidism Between 2001 and 2015: An Observational Study of 929,684 Primary Care Patients in Copenhagen

Medici, Bjarke Borregaard; Nygaard, Birte; Cour, Jeppe Lerche la; Grand, Mia Klinten; Siersma, Volkert; Nicolaisdóttir, Dagný Rós; Lind, Bent; Olivarius, Niels de Fine; Andersen, Christen Lykkegaard

doi:10.1089/thy.2018.0539

Cited by 46 publications

(48 citation statements)

References 32 publications

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“…This could seem contrary to our results though an increase in treatment of subclinical hypothyroidism seems the more likely explanation. Evidence exists to suggest a lower s‐TSH threshold for initiating L‐T 4 treatment among hypothyroid patients in Copenhagen between 2001 and 2015 . The median s‐TSH upon initiation of L‐T 4 treatment was 10 mU/L in 2001 and 6.8 in 2015 .…”

Section: Discussionmentioning

confidence: 99%

“…Evidence exists to suggest a lower s‐TSH threshold for initiating L‐T 4 treatment among hypothyroid patients in Copenhagen between 2001 and 2015 . The median s‐TSH upon initiation of L‐T 4 treatment was 10 mU/L in 2001 and 6.8 in 2015 . Treating subclinical cases of hypothyroidism could ensure that patients never become overtly hypothyroid, thus remaining undetected by our surveillance programme.…”

Section: Discussionmentioning

confidence: 99%

“…This could, however, lead to an underestimation of the substantial reduction in SIR of overt verified thyrotoxicosis and the absent increase in SIR of overt verified hypothyroidism. In Copenhagen, the annual number of s‐TSH measurement increased 164% from 2001 to 2015 …”

Section: Discussionmentioning

confidence: 99%

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Changes in subtypes of overt thyrotoxicosis and hypothyroidism following iodine fortification

Petersen

Pedersen

Knudsen

et al. 2019

Clinical Endocrinology

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Objective To investigate the impact of mandatory iodine fortification (IF) on the incidence of nosological subtypes of overt thyrotoxicosis and hypothyroidism. Design We identified and scrutinized all possible new cases of overt thyrotoxicosis and hypothyroidism in an open cohort in Northern Jutland (n = 309 434; 1 January 1997) during the years 2014‐2016. Individual medical history was evaluated to verify and detail the incidence of overt thyroid dysfunction and for classification into nosological subtypes. A number of cases were excluded during final verification due to spontaneous normalization of thyroid function, as they had no medical history suggesting a known condition, which could transiently affect thyroid function (subacute/silent thyroiditis, PPTD and iatrogenic thyroid dysfunction). An identical survey was conducted in 1997‐2000 prior to mandatory IF of salt (13 µg/g) that was in effect from year 2001. Results The standardized incidence rate (SIR) of verified overt thyrotoxicosis decreased markedly from 97.5/100 000/year in 1997‐2000 to 48.8 in 2014‐2016 (SIRR: 0.50 [95% CI: 0.45‐0.56]). This was due to a distinct decrease in the SIR of multinodular toxic goitre (SIRR: 0.18 [0.15‐0.23]), solitary toxic adenoma (SIRR: 0.26 [0.16‐0.43]) and to a lesser degree Graves’ disease (SIRR: 0.67 [0.56‐0.79]). SIR for overt hypothyroidism was unaltered by 2014‐2016 (SIRR: 1.03 [0.87‐1.22]). However, age distribution shifted with more young and fewer elderly cases of verified overt hypothyroidism. Conclusion Mandatory IF caused a substantial reduction in SIR of verified overt thyrotoxicosis (especially of nodular origin) while avoiding an increase in SIR of verified overt hypothyroidism.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Changes in subtypes of overt thyrotoxicosis and hypothyroidism following iodine fortification

Petersen

Pedersen

Knudsen

et al. 2019

Clinical Endocrinology

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“…Many more people have subclinical hypothyroidism, with a prevalence estimated as 8% in women (10% in women aged >55 years) and 3% of men [4]. Current recommendations support the prescription of levothyroxine to some patients with subclinical hypothyroidism, particularly where TSH is >10 mU/L and FT4 is within the normal range [2], and the use of levothyroxine for the management of subclinical hypothyroidism appears to have increased [6,7].…”

Section: Introductionmentioning

confidence: 99%

Managing symptoms in hypothyroid patients on adequate levothyroxine: a narrative review

Razvi

Mrabeti²,

Luster

2020

Endocrine Connections

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The current standard of care for hypothyroidism is levothyroxine (LT4) monotherapy to reduce levels of thyrotropin (thyroid stimulating hormone, TSH) to within its reference range and amelioration of any symptoms. A substantial minority continue to report hypothyroid-like symptoms despite optimised TSH, however. These symptoms are not specific to thyroid dysfunction and are frequent among the euthyroid population, creating a therapeutic dilemma for the treating clinician as well as the patient. We present a concise, narrative review of the clinical research and evidence-based guidance on the management of this challenging population. The clinician may endeavour to ensure that the serum TSH is within the target range. However, the symptomatic patient may turn to alternative non-evidence-based therapies in the hope of obtaining relief. Accordingly, it is important for the clinician to check for conditions unrelated to the thyroid that could account for the ongoing symptoms such as other autoimmune conditions, anaemia or mental health disorders. Systematic and thorough investigation of the potential causes of persistent symptoms while receiving LT4 therapy will resolve the problem for most patients. There may be some patients that may benefit from additional treatment with liothyronine (LT3), although it is unclear as yet as to which patient group may benefit the most from combined LT4 + LT3 therapy. In the future, personalised treatment with LT4 + LT3 may be of benefit for some patients with persistent symptoms of hypothyroidism such as those with polymorphisms in the deiodinase enzyme 2 (DIO2). For now, this remains a subject for research.

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“…This study (4) suggests that GPs in this sample have increasingly considered the known unfavorable impact of thyroid dysfunction on overall health. Unfortunately, this awareness has likely resulted in an excessive number of serum TSH measurements being performed, as the increase in number of TSH examinations conducted between 2010 and 2015 did not detect increasingly more hypothyroid patients during this time frame.…”

Section: Commentarymentioning

confidence: 81%

Decreased Threshold for Initiating L-T₄ Therapy in a Primary Care Population Over a 15-Year Period

GuanHaixia

2019

Clinical Thyroidology

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Background Increased focus on well-being and quality-of-life issues in the management of various diseases has led to the earlier diagnosis and subsequent treatment of hypothyroidism in many patients seen by primary care physicians. In order to weigh the risks and benefits of thyroid hormone replacement therapy, recommendations concerning the diagnosis of hypothyroidism and initiation of levothyroxine (L-T 4) have been developed (1,2). The median serum TSH prompting the initiation of L-T 4 among over 52,000 individuals in the United Kingdom decreased from 8.7 mIU/L to 7.9 mIU/L between 2001 and 2009 (3), thus raising concerns about L-T 4 overuse and its potential harm. The current study (4) was performed to assess changes in thyroid hormone prescriptions for the treatment of hypothyroidism among general practitioners in Copenhagen between 2001 and 2015.

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Changes in Prescription Routines for Treating Hypothyroidism Between 2001 and 2015: An Observational Study of 929,684 Primary Care Patients in Copenhagen

Cited by 46 publications

References 32 publications

Changes in subtypes of overt thyrotoxicosis and hypothyroidism following iodine fortification

Changes in subtypes of overt thyrotoxicosis and hypothyroidism following iodine fortification

Managing symptoms in hypothyroid patients on adequate levothyroxine: a narrative review

Decreased Threshold for Initiating L-T₄ Therapy in a Primary Care Population Over a 15-Year Period

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Changes in Prescription Routines for Treating Hypothyroidism Between 2001 and 2015: An Observational Study of 929,684 Primary Care Patients in Copenhagen

Cited by 46 publications

References 32 publications

Changes in subtypes of overt thyrotoxicosis and hypothyroidism following iodine fortification

Changes in subtypes of overt thyrotoxicosis and hypothyroidism following iodine fortification

Managing symptoms in hypothyroid patients on adequate levothyroxine: a narrative review

Decreased Threshold for Initiating L-T4 Therapy in a Primary Care Population Over a 15-Year Period

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Decreased Threshold for Initiating L-T₄ Therapy in a Primary Care Population Over a 15-Year Period