Forgotten drugs: long-term prescriptions of thyroid hormones – a cross-sectional study

Abstract

BackgroundThyroid hormones are among the most prescribed drugs in Germany. Although iodine supply has been improving in the last decade, annual prescriptions for thyroid hormones are rising. The aim of this study was to provide prevalence of thyroid hormone prescribing and to explore reasons for thyroid hormone prescription in primary care settings.Study designA cross-sectional study.MethodsData collection took place in six general practitioner (GP) practices in Hesse, Germany. We used the records of six GP practices to estimate prevalence of thyroid hormone prescribing. All patients who received a prescription of the active ingredient levotyroxine during the preceding 3 months were mailed a study invitation. A proportion of the identified patients were interviewed. In addition, demographical data and all medical findings related to thyroid disease were recorded.ResultsOn average, 9.2% (SD 4.6) of all patients from participating practices were taking thyroid hormones. The majority were female (82.5%). In 47.7% of the study participants, the GP’s diagnosis, according to their records, was nonexistent. In 13.6% of cases, the documentation of the diagnostic information was incomplete. While 25% of interviewed patients with high educational background initiated further diagnostic investigation, only 4.4% of the patients with lower education did so.ConclusionIn the majority of patients treated with thyroid hormones, doctors had not documented the precise indication for prescription.

International variation in GP treatment strategies for subclinical hypothyroidism in older adults: a case-based survey

“…A recent cross-sectional study showed that 9% of patients in GP practices in Germany are taking thyroid medication. 23 At present, in Germany, guidelines for GPs are being developed. The exact reasons for the high prescription rates in Germany are not known.…”

“…The exact reasons for the high prescription rates in Germany are not known. 23 The current remuneration procedures of the German health system, and the lack of guidelines, may perhaps explain why the GPs from this country were more often inclined to start treatment than in the other countries, and chose higher starting doses.…”

Appropriateness of prescribing thyroxine in primary care

“…8 They postulated that thyroxine may have been prescribed as an intervention for unexplained medical symptoms.…”

“…In a study looking at thyroxine prescription in six GP practices in Germany, the authors found that a GP diagnosis was non-existent in 47.7% of patients. 8 They postulated that thyroxine may have been prescribed as an intervention for unexplained medical symptoms.…”

Typology of drug discontinuation trials - Methodological recommendations

“…Diagnosis of relevant thyroid disease often dates back many years, the original documentation is often lost, and doctors re-prescribe the medication with the assumption that there has been some justification in the past. Attempts to stop the drug often meet patients' resistance [21] . In order to gain evidence for this dilemma, a DDT trial investigating discontinuation procedures and evaluating complex strategies would be helpful.…”