TY  - BOOK
AU  - Burman, Kenneth D
TI  - A 2013 survey of clinical practice patterns in the management of primary hypothyroidism
SN  - 0021-972X
PY  - 2014///
KW  - *Hypothyroidism/th [Therapy]
KW  - *Physician's Practice Patterns/sn [Statistics & Numerical Data]
KW  - Adult
KW  - Age Factors
KW  - Aged
KW  - Aged, 80 and over
KW  - Data Collection
KW  - Female
KW  - Guideline Adherence/sn [Statistics & Numerical Data]
KW  - Humans
KW  - Hypothyroidism/ep [Epidemiology]
KW  - Male
KW  - Middle Aged
KW  - Physician's Practice Patterns/st [Standards]
KW  - Pregnancy
KW  - Questionnaires
KW  - Societies, Medical/st [Standards]
KW  - Young Adult
KW  - MedStar Washington Hospital Center
KW  - Medicine/Endocrinology
KW  - Journal Article
N1  - Available online through MWHC library: 1999- June 2013, Available in print through MWHC library: 1999 - 2006
N2  - CONCLUSION: The current survey of clinical endocrinologists catalogs current practice patterns in the management of hypothyroidism and demonstrates 1) a nearly exclusive preference for l-T4 alone as initial therapy, 2) the widespread use of age-specific TSH targets for replacement therapy, 3) a low threshold for treating mild thyroid failure, 4) meticulous attention to TSH targets in the pregnant and prepregnant woman, and 5) a highly variable approach to both the rate and means of restoring euthyroidism for overt disease. Both alignment and focal divergence from recent CPGs are demonstrated; CONTEXT: In 2012, comprehensive clinical practice guidelines (CPGs) were published regarding the management of hypothyroidism; METHODS: Clinical members of The Endocrine Society (TES), the ATA, and the AACE were asked to take a web-based survey consisting of 30 questions dealing with testing, treatment, and modulating factors in the management of primary hypothyroidism; OBJECTIVE: We sought to document current practices in the management of primary hypothyroidism and compare these results with recommendations made in the 2012 American Thyroid Association (ATA)/American Association of Clinical Endocrinologists (AACE) hypothyroidism CPGs. In addition, we sought to examine differences in management among international members of U.S.-based endocrine societies and to compare survey results with those obtained from a survey of ATA members performed 12 years earlier; RESULTS: In total, 880 respondents completed the survey, including 618 members of TES, 582 AACE members, and 208 ATA members. North American respondents accounted for 67.6%, Latin American 9.7%, European 9.2%, Asia and Oceania 8.1%, and Africa and Middle East 5.5%. Overt hypothyroidism would be treated using l-T4 alone by 99.2% of respondents; 0.8% would use combination l-T4 and liothyronine (l-T3) therapy. Generic l-T4 would be used by 49.3% and a brand name by 49.9%. The rate of replacement would be gradual (38.5%); an empiric dose, adjusted to achieve target (33.6%); or a calculated full replacement dose (27.8%). A target TSH of 1.0 to 1.9 mU/L was favored in the index case, but 3.0 to 3.9 mU/L was the most commonly selected TSH target for an octogenarian. Persistent hypothyroid symptoms despite achieving a target TSH would prompt testing for other causes by 84.3% of respondents, a referral to primary care by 11.3%, and a 140822 to l-T4 plus l-T3 therapy by 3.6%. Evaluation of persistent symptoms would include measurement of T3 levels by 21.9% of respondents. Subclinical disease with a TSH 5.0 to 10.0 mU/L would be treated without further justification by 21.3% of respondents, or in the presence of positive thyroid peroxidase antibodies (62.3%), hypothyroid symptoms (60.9%), high low-density lipoprotein (52.9%), or goiter (46.6%). The TSH target for a newly pregnant patient was <2.5 mU/L for 96.1% of respondents, with 63.5% preferring a TSH target <1.5 mU/L. Thyroid hormone levels would be checked every 4 weeks during pregnancy by 67.7% and every 8 weeks by an additional 21.4%. A hypothyroid patient with TSH of 0.5 mU/L who becomes pregnant would receive an immediate l-T4 dose increase by only 36.9% of respondents
UR  - http://dx.doi.org/10.1210/jc.2014-1046
ER  -