000			03852nam a22003617a 4500
008			190314s20192019 xxu||||| |||| 00| 0 eng d
022			_a1664-2392
024			_a10.3389/fendo.2019.00031 [doi]
024			_aPMC6363658 [pmc]
040			_aOvid MEDLINE(R)
099			_a30761091
245			_aShort-Term Time Trends in Prescribing Therapy for Hypothyroidism: Results of a Survey of American Thyroid Association Members.
251			_aFrontiers in Endocrinology. 10:31, 2019.
252			_aFront Endocrinol (Lausanne). 10:31, 2019.
253			_aFrontiers in endocrinology
260			_c2019
260			_fFY2019
265			_sepublish
266			_d2019-03-14
520			_a<b>Objective:</b> Hypothyroid patients frequently request specific therapies from their physicians. Combination therapy is vigorously discussed at professional meetings. We wished to determine if physician prescribing patterns for hypothyroidism changed during 2017 after specific educational events. <b>Methods:</b> A survey addressing treatment of hypothyroidism was emailed to American Thyroid Association (ATA) members on three occasions in 2017. The Spring emails were sent prior to a satellite symposium addressing hypothyroidism, and prior to the annual Endocrine Society and ATA meetings; the December emails were sent after these events. Physicians were presented with thirteen theoretical patients and chose from 6 therapeutic options, including levothyroxine, synthetic combination therapy, thyroid extract, and liothyronine monotherapy. The patient scenarios successively incorporated factors potentially providing reasons for considering combination therapy. Multivariate repeated measures logistic regression analyses first examined effects of physician characteristics on prescribing the various therapies. Then, analyses also incorporated timing, by comparing prescribing patterns in February, March, and December. <b>Results:</b> In analyses of prescribing levothyroxine monotherapy vs. any T3 therapy, there was a trend of borderline significance (p = 0.053) for T3 therapy to be prescribed more in December compared with February-March combined. When multivariate analyses were performed controlling for time and physician characteristics, choice of therapy was only significantly affected by country of practice (OR 1.7, CI 1.3-2.2). Physician choice of therapies was also examined for the options of continuing (1) levothyroxine, vs. (2) increasing levothyroxine, (3) adding liothyronine either with or without levothyroxine reduction, or (4) replacing levothyroxine with desiccated thyroid extract or liothyronine. When multivariate analyses incorporating time and physician characteristics were performed, respondents in December (OR 1.5, CI 1.0-2.3) and those practicing in North America (OR 1.8, CI 1.2-2.6) were more likely to prescribe liothyronine. <b>Conclusions:</b> This survey shows that although current North American guidelines do not recommend combination therapy, such therapy is being prescribed more over time and is also more commonly prescribed in North America. It is possible our guidelines are failing to incorporate evidence that physicians are considering when prescribing combination therapy. Such evidence could include data about patient preferences, and this needs to be a focus of future studies.
546			_aEnglish
650			_aIN PROCESS -- NOT YET INDEXED
651			_aMedStar Health Research Institute
651			_aMedStar Washington Hospital Center
656			_aMedicine/Endocrinology
657			_aJournal Article
700			_aJonklaas, Jacqueline
700			_aShara, Nawar M
700			_aTefera, Eshetu
790			_aJonklaas J, Shara N, Tefera E
856			_uhttps://dx.doi.org/10.3389/fendo.2019.00031 _zhttps://dx.doi.org/10.3389/fendo.2019.00031
942			_cART _dArticle
999			_c4146 _d4146