Influence of educational level on test and treatment for incident hypothyroidism

Møllehave, Line Tang; Jacobsen, Rikke Kart; Linneberg, Allan; Skaaby, Tea; Knudsen, Nils; Jørgensen, Torben; Kårhus, Line Lund; Kriegbaum, Margit; Grand, Mia Klinten; Siersma, Volkert; Lind, Bent; Andersen, Christen Lykkegaard; Nygaard, Birte; Medici, Bjarke Borregaard; Pedersen, Inge Bülow; Ravn‐Haren, Gitte; Thuesen, Betina H.

doi:10.1111/cen.14429

Cited by 5 publications

(7 citation statements)

References 33 publications

(62 reference statements)

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“…There was no significant difference between the two groups (normal thyroid function and SCH) concerning their educational levels. This is similar to the results of Mollehave, Tang L, et al, who did their study on the effect of level of education on incident testing and treatment for SCH and did not find any difference between education and hypothyroidism [ 19 ]. The dietary habits of both groups were almost the same, and the effect of dietary nutrients on thyroid function can be excluded.…”

Section: Discussionsupporting

confidence: 89%

A Cross-Sectional Study of the Relationship Between Perceived Stress and Thyroid Function Among Apparently Normal Women in the Reproductive Age

Puttaswamy,

Nandibewur,

Kumar

et al. 2024

Cureus

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Background: A substantial majority of women in India report experiencing stress frequently, with a significant number indicating a lack of time for relaxation. Women within a central productive age bracket often report higher stress levels. Chronic stress can lead to the development of autoimmune disorders affecting the thyroid gland. Objective: To evaluate the relationship between perceived stress and thyroid function among apparently normal women of reproductive age. Materials and methods: The present study was conducted at the Vijayanagar Institute of Medical Sciences (VIMS) after obtaining clearance from the Institutional Ethical Committee and informed written consent from the participants. One hundred and fourteen working women aged 20-49 who consented to the study and had no personal or family history of medical illness or thyroid disease were randomly selected. Stress levels were measured using a Perceived Stress Scale (PSS), and thyroid parameters (total triiodothyronine [T3], total thyroxine [T4], and thyroid-stimulating hormone [TSH]) in blood samples were assessed by the electrochemical luminescence immunoassay method. Anthropometric parameters such as age and body mass index (BMI), as well as vital parameters like pulse rate and blood pressure, were measured for all participants. A detailed history was also recorded, including marital status, duration of married life, education, number of children, type of family, per capita income, phase of menstrual cycle, and dietary habits. Results: The Statistical Package for the Social Sciences (SPSS) software version 22.0 was used for statistical analysis. The analysis used Pearson's chi-square test, Student's t-test, and binary logistic regression. A positive correlation was observed between PSS and TSH (correlation coefficient "r" value = 0.060) without a significant p-value. Participants were divided into two groups based on TSH values: those with normal thyroid function (TSH <4.2 international units [IU]) and those with subclinical hypothyroidism (SCH) (TSH >4.2 IU). Both groups had total T3 and T4 levels within the normal reference range. A highly significant difference was observed for age, BMI, TSH, marital status, and duration of married life between women with normal thyroid function and those with SCH. No significant difference was found between the two groups for PSS. Discussion: Both acute and chronic stress affect thyroid function through the hypothalamus-pituitary-thyroid (HPT) axis and the hypothalamus-pituitary-adrenal (HPA) axis. Psychological and physiological stressors induce immune modulations that can lead to autoimmune thyroid diseases, resulting in hypothyroidism. Conclusion: The study examined the link between stress and thyroid health in women of childbearing age, revealing a trend where higher stress levels corresponded with increased TSH levels, though not significantly. It also found that older age, higher BMI, and longer duration of marriage were linked to a greater occurr...

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Section: Discussionsupporting

confidence: 89%

A Cross-Sectional Study of the Relationship Between Perceived Stress and Thyroid Function Among Apparently Normal Women in the Reproductive Age

Puttaswamy,

Nandibewur,

Kumar

et al. 2024

Cureus

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“…The most recent meta-analysis from 2018 (2) concluded that among non-pregnant adults with SCH, the use of thyroid hormone therapy was not associated with improvements in general quality of life or thyroid-related symptoms. Despite the lack of proven benefit there is an increased public debate on social media between people with potential thyroid disease, and there seems to be an expectation of treatment among some groups, especially those with high income (3). This may, in part, explain the observation of a declining TSH threshold for initiating therapy with levothyroxine (L-T4) for hypothyroidism from 10 mIU/L in 2001 to 6.8 mIU/L in 2015 in Denmark (1) with similar observations in the UK (4).…”

Section: Introductionmentioning

confidence: 99%

Risk of over- and under- treatment with levothyroxine in primary care in Copenhagen, Denmark

Cour

Medici

Grand

et al. 2021

European Journal of Endocrinology

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Objective: A decrease over time in thyroid stimulating hormone (TSH) levels when initiating levothyroxine (L-T4) therapy for hypothyroidism has been reported, where treatment most often is initiated with TSH levels below 10 mIU/L. The primary objective of this study was to investigate whether this lower TSH threshold resulted in an increased number of overtreated patients. Design and Method: Retrospective cohort study comprising inhabitants in Copenhagen who had TSH measurements requested by general practitioners which led to a new prescription of L-T4 between 2001 and 2012. Over- and undertreatment were defined as TSH < 0.1 mIU/L or above 10 mIU/mL, respectively, in three consecutive measurements. Data were analysed by Aalen-Johansen estimators and Cox proportional hazards models. Results: In total, 14,533 initiations of L-T4 in the study. The cumulative risk of being over- or undertreated, was 4.7% and 7.4% after 10 years. The hazard of overtreatment was higher among women, younger adults and with lower initial TSH levels. The hazard of overtreatment decreased over the time period from 2001 to 2012. Among overtreated individuals, the chance of returning to a normal TSH was about 55% after 10 years. In 18% of the cases, L-T4 therapy was initiated on TSH levels less than 5 mIU/L. Conclusion: Although a still decreasing threshold for initiating L-T4 therapy is known, the risk of overtreatment (and undertreatment) was low and lessened in the period 2001 – 2012 among Danish primary care patients. Nevertheless, as many as 18% were started on L-T4 with normal TSH levels.

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“…It is not a surprise that educational level and sex influence prescriptions of DTE and L-T3, as it was recently described that educational level (as an indicator of cognitive and analytical skills (5)) was a factor in initiating L-T4 treatment with normal TSH (4). The same applies to the fact that women are more prone to DTE and L-T3 therapy and starting therapy with normal TSH (19).…”

Section: Discussionmentioning

confidence: 96%

“…The increase in L-T4 therapy and falling threshold may be due to increasing demand from patients (3). A recent study demonstrates that the probability of starting thyroid hormone therapy despite normal TSH was higher in persons with long education (4). Educational level is a marker of social status and may indicate the ability to access health information and increased argumentative skills (5).…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic influence on treatment with liothyronine and desiccated thyroid extract in Denmark

Cour

Møllehave

Medici

et al. 2022

European Thyroid Journal

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Introduction High compared with low educational level increases the odds of starting levothyroxine (L-T4) with a normal TSH – the mechanism is most likely patient request. The use of liothyronine (L-T3) and desiccated thyroid extract (DTE) is also speculated to be initiated at patients’ request. Therefore, the primary aim of this study was to evaluate if educational level influences treatment with L-T3 and DTE. Material and methods In this register-based cross-sectional study we included all Danish citizens ≥30 years with redeemed prescription of L-T4, L-T3, or DTE during 2017- 2020. We defined educational levels as short, medium, and long (<10 years, 10-12 years, and above 12 years, respectively). The association between educational level and treatment with LT3 or DTE vs. only LT4 was analyzed in logistic regression models adjusted for age and sex. Results We included 154,360 individuals using thyroid medication of whom 3,829 were treated with L-T3 (2.48%) and 430 with DTE (0.28%). The usage was highest among women (3.15%) and the age group 40–49 (5.6%). Longer education compared with short increased the odds of being treated with DTE or L-T3 (medium education OR 1.61 (95% CI 1.50–1.8) and long education OR 1.95 (95% CI 1.79–2.13)). Test for trend OR 1.37 (95% CI 1.31–1.42). Adjustment for other covariates did not affect the results substantially. Conclusion Persons with a longer compared to a shorter education are more often treated with either DTE or L-T3, and the usage of these drugs is limited to less than 3% of thyroid hormone users.

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Influence of educational level on test and treatment for incident hypothyroidism

Cited by 5 publications

References 33 publications

A Cross-Sectional Study of the Relationship Between Perceived Stress and Thyroid Function Among Apparently Normal Women in the Reproductive Age

A Cross-Sectional Study of the Relationship Between Perceived Stress and Thyroid Function Among Apparently Normal Women in the Reproductive Age

Risk of over- and under- treatment with levothyroxine in primary care in Copenhagen, Denmark

Socioeconomic influence on treatment with liothyronine and desiccated thyroid extract in Denmark

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