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THE IMPACT OF AGE IN THE MANAGEMENT OF HYPOTHYROIDISM: RESULTS OF A NATIONWIDE SURVEY.
Endocr Pract. 2016 Jun; 22(6):708-15.EP

Abstract

OBJECTIVE

Evidence exists that thyroid-stimulating hormone (TSH) increases with age and lowering the TSH goal in older patients on thyroid hormone may cause over-treatment. Risks of overtreatment include cardiac and skeletal events. We assessed practice patterns regarding TSH goals and explored factors influencing physicians' decision making when managing hypothyroidism.

METHODS

Members of the American College of Physicians, the American Academy of Family Practice, and the Endocrine Society were surveyed to determine goal TSH when treating hypothyroidism.

RESULTS

Fifty-three percent of physicians reported factoring patient age into their decision making when managing hypothyroidism. Patient age was prioritized third (53%), following patient symptoms (69.2%) and cardiac arrhythmias (65.7%). In multivariable analysis, endocrinologists (P = .002), internists (P = .049), physicians in academic settings (P = .003), and high-volume physicians (P = .021) were more likely to consider patient age when determining goal TSH. When presented with scenarios differing in patient gender and age, 90% of physicians targeted a TSH ≤3.0 mIU/L in 30-year-old patients. Fifty-three percent of respondents targeted a TSH ≤3.0 mIU/L in octogenarians, but 90% targeted a TSH >1.5 mIU/L in this group. Regardless of gender, physician-reported TSH goal ranges (0.1 to 0.5, 0.6 to 1.5, 1.6 to 3.0, and 3.1 to 5.0 mIU/L) increased in a direct relationship to patient age (P<.001).

CONCLUSION

Just over half of physicians consider patient age when determining TSH goal. When presented with scenarios differing in patient age and gender, physicians targeted a higher TSH goal in octogenarians. This may indicate an attempt to avoid overtreatment in this group. Consensus is needed among physicians regarding the role of patient age in hypothyroidism management.

ABBREVIATIONS

TSH = thyroid-stimulating hormone.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26866707

Citation

Papaleontiou, Maria, et al. "THE IMPACT of AGE in the MANAGEMENT of HYPOTHYROIDISM: RESULTS of a NATIONWIDE SURVEY." Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, vol. 22, no. 6, 2016, pp. 708-15.
Papaleontiou M, Gay BL, Esfandiari NH, et al. THE IMPACT OF AGE IN THE MANAGEMENT OF HYPOTHYROIDISM: RESULTS OF A NATIONWIDE SURVEY. Endocr Pract. 2016;22(6):708-15.
Papaleontiou, M., Gay, B. L., Esfandiari, N. H., Hawley, S. T., & Haymart, M. R. (2016). THE IMPACT OF AGE IN THE MANAGEMENT OF HYPOTHYROIDISM: RESULTS OF A NATIONWIDE SURVEY. Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 22(6), 708-15. https://doi.org/10.4158/EP151021.OR
Papaleontiou M, et al. THE IMPACT of AGE in the MANAGEMENT of HYPOTHYROIDISM: RESULTS of a NATIONWIDE SURVEY. Endocr Pract. 2016;22(6):708-15. PubMed PMID: 26866707.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - THE IMPACT OF AGE IN THE MANAGEMENT OF HYPOTHYROIDISM: RESULTS OF A NATIONWIDE SURVEY. AU - Papaleontiou,Maria, AU - Gay,Brittany L, AU - Esfandiari,Nazanene H, AU - Hawley,Sarah T, AU - Haymart,Megan R, Y1 - 2016/02/01/ PY - 2016/2/12/entrez PY - 2016/2/13/pubmed PY - 2016/2/13/medline SP - 708 EP - 15 JF - Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists JO - Endocr Pract VL - 22 IS - 6 N2 - OBJECTIVE: Evidence exists that thyroid-stimulating hormone (TSH) increases with age and lowering the TSH goal in older patients on thyroid hormone may cause over-treatment. Risks of overtreatment include cardiac and skeletal events. We assessed practice patterns regarding TSH goals and explored factors influencing physicians' decision making when managing hypothyroidism. METHODS: Members of the American College of Physicians, the American Academy of Family Practice, and the Endocrine Society were surveyed to determine goal TSH when treating hypothyroidism. RESULTS: Fifty-three percent of physicians reported factoring patient age into their decision making when managing hypothyroidism. Patient age was prioritized third (53%), following patient symptoms (69.2%) and cardiac arrhythmias (65.7%). In multivariable analysis, endocrinologists (P = .002), internists (P = .049), physicians in academic settings (P = .003), and high-volume physicians (P = .021) were more likely to consider patient age when determining goal TSH. When presented with scenarios differing in patient gender and age, 90% of physicians targeted a TSH ≤3.0 mIU/L in 30-year-old patients. Fifty-three percent of respondents targeted a TSH ≤3.0 mIU/L in octogenarians, but 90% targeted a TSH >1.5 mIU/L in this group. Regardless of gender, physician-reported TSH goal ranges (0.1 to 0.5, 0.6 to 1.5, 1.6 to 3.0, and 3.1 to 5.0 mIU/L) increased in a direct relationship to patient age (P<.001). CONCLUSION: Just over half of physicians consider patient age when determining TSH goal. When presented with scenarios differing in patient age and gender, physicians targeted a higher TSH goal in octogenarians. This may indicate an attempt to avoid overtreatment in this group. Consensus is needed among physicians regarding the role of patient age in hypothyroidism management. ABBREVIATIONS: TSH = thyroid-stimulating hormone. SN - 1530-891X UR - https://www.unboundmedicine.com/medline/citation/26866707/THE_IMPACT_OF_AGE_IN_THE_MANAGEMENT_OF_HYPOTHYROIDISM:_RESULTS_OF_A_NATIONWIDE_SURVEY_ L2 - http://journals.aace.com/doi/10.4158/EP151021.OR?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
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