Patients’ attitudes and perceptions towards treatment of hypothyroidism in general practice: an in-depth qualitative interview study

Abstract

BackgroundSuboptimal thyroid hormone replacement is common in patients with hypothyroidism and the behavioural factors underlying this are poorly understood.AimTo explore the attitudes and perceptions of patients to thyroid hormone replacement therapy.Design & settingAn in-depth qualitative interview study with patients with hypothyroidism residing in Northumberland, and Tyne and Wear, UK.MethodTwenty-seven patients participated, of which 15 patients had thyroid stimulating hormone (TSH) levels within the reference range (0.4–4.0 mU/L) and 12 patients had TSH levels outside the reference range. A grounded theory approach was used to explore and develop emerging themes, which were mapped to the health belief model (HBM).ResultsPatients generally had a low understanding of their condition or of the consequences of suboptimal thyroid hormone replacement. Patients that had experienced hypothyroid symptoms at initial diagnosis had a better perception of disease susceptibility, and this was reflected in excellent adherence to levothyroxine in this group of patients. The main benefits of optimal thyroid replacement were improved wellbeing and performance. However, patients who remained unwell despite a normal serum TSH level felt that their normal result presented a barrier to further evaluation of their symptoms by their GP.ConclusionEducating patients with hypothyroidism regarding the consequences of inadequate thyroid hormone replacement may reduce barriers and improve treatment outcomes. An over-reliance on TSH as a sole marker of wellbeing reduced opportunities for clinicians to address patient symptoms. Evaluating symptoms in combination with biochemical indices, may lead to better patient outcomes than relying on laboratory tests alone.

Attitudes and perceptions of health professionals towards management of hypothyroidism in general practice: a qualitative interview study

“… 43 Poor levothyroxine adherence, medication interactions and comorbidities have been reported to have an effect on thyroid replacement therapy, 44 which were some of the barriers reported in this study. However, in our qualitative interview study with patients with hypothyroidism, although not generalisable outside of the patient population, good levothyroxine adherence was reported by nearly all patients, even those who had TSH levels outside of the reference range, 29 suggesting that the reasons for inadequate thyroid treatment may lie deeper than the typical assumptions by health professionals that poor adherence is the main reason for suboptimal treatment. 22 23 …”

“…Deliberate TSH suppression (<0.1 mU/L) with high doses of levothyroxine, which was avoided by the majority of GPs in our study, is not recommended due to the potential risk of heart disease, stroke, osteoporosis and fractures. 41 In our previously published work with patients with hypothyroidism, patients felt that health professionals were more inclined to treat their TSH levels than their symptoms and that they were not given very much information at the time of diagnosis, 29 as reported by some health professionals in this study.…”

“…To address this problem, we previously explored the attitudes and perceptions of patients with hypothyroidism towards their treatment. 29 In the present study, we have investigated the attitudes and perceptions towards the management of hypothyroidism among health professionals including GPs, nurse practitioners (NPs), pharmacists and practice nurses. We sought to determine the clinical management and behavioural factors that may influence the adequacy of thyroid hormone replacement in patients with hypothyroidism.…”

Negative illness perceptions are related to poorer health‐related quality of life among thyroid cancer survivors: Results from the PROFILES registry

“…34,35 Noteworthy, health care professionals acknowledge and underscore the difficulty of attributing symptoms to thyroid disease when with hormones-treated patient's clinical blood levels are within range. 36 Extra caution is therefore warranted when administering patients' additional thyroid hormones, just in case symptom are from their thyroid disease. 36 Interestingly, disease understanding was unrelated to HRQoL in our DTC survivors, although previous studies among other patient populations have also reported nonsignificant findings.…”

“…36 Extra caution is therefore warranted when administering patients' additional thyroid hormones, just in case symptom are from their thyroid disease. 36 Interestingly, disease understanding was unrelated to HRQoL in our DTC survivors, although previous studies among other patient populations have also reported nonsignificant findings. 17,29 A former study among DTC patients revealed that a higher level of disease understanding was associated however with less negative emotional perceptions.…”