Management of primary hypothyroidism in adults: An analysis of the results of a survey in 546 primary care physicians.

Abstract

OBJECTIVE\nTo document current practices in the management of adult patients with hypothyroidism in the setting of primary healthcare.\n\n\nMETHODS\nWe designed a web-based survey to inquire information on real-life practices regarding management of hypothyroidism by primary care physicians in the region of Madrid (Spain).\n\n\nRESULTS\nIn total, 546 out of 3897 (14%) physicians (aged 50.9±8.5 yr, 404 females) completed the survey. More than 90% of respondents requested serum thyrotropin measurement in subjects with symptoms of thyroid hypofunction, family history of thyroid disease and history of autoimmune disease. A thyroid ultrasound was requested to evaluate subclinical and overt hypothyroidism by 27.1% and 69.6% of respondents, respectively. Only 22.1% of respondents stated that they do not treat subclinical hypothyroidism with thyrotropin values less than 10mU/l. Most physicians use brand-name formulations of levothyroxine and advise patients on how to take the tablets. To start treatment, the gradual replacement rate was the option chosen by most of the respondents, even in young patients. The thyrotropin target preferred by most respondents was 0.5-5.0mU/l, especially in older patients. In patients with persistent symptoms, 61.4% search for the causes through complementary investigations. A longer professional practice time was not always accompanied by better adherence to guidelines and expert recommendations.\n\n\nCONCLUSION\nOur results reveal a proactive attitude in the diagnosis and of therapy by most of the respondents. However, we observed a tendency to perform unnecessary diagnostic tests and an excessive propensity to treat mild subclinical hypothyroidism.