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Patient age important in determining TSH goals in hypothyroidism
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Patient age should be considered by health care providers when determining thyroid-stimulating hormone goal for the treatment of hypothyroidism, according to physicians responding to a practice survey.
Maria Papaleontiou, MD, assistant professor of internal medicine at the University of Michigan in Ann Arbor, and colleagues surveyed 389 members of the American College of Physicians, American Academy of Family Physicians, and the Endocrine Society to determine the different TSH goals used when treating hypothyroidism.
Thirty-six percent of participants were endocrinologists, followed by family practitioners (35.2%), internists (26.4%) and other (2.2%). Private practice was the most common setting (49%), followed by academic settings (19.9%), other settings (17.6%) and community-based academic affiliates (13.5%).
Patient age was reported by 53% of participants as an important factor for decision making related to goal TSH in treating hypothyroidism; 69.2% reported patient symptoms and 65.7% reported cardiac arrhythmias as important. Less commonly, skeletal issues such as osteoporosis (43.4%), fractures (27.2%) and multiple falls (7.7%) were considered in decision making. Pregnancy (40.6%) and interest in conception (27.2%) were reported as important factors; 12% of participants reported none of the previously mentioned patient characteristics as important.
The importance placed on patient age was associated with physician sex (P = .017), physician specialty (P < .001), practice setting (P = .01) and patient volume (P < .001). More endocrinologists considered patient age important (75%) compared with internists (43.8%) and family physicians (35.6%).
A TSH of 3 mIU/L or less in a patient aged 30 years was recommended by 90% of providers, and 53% reported they would continue to target that goal in adults aged 80 to 89 years. Reported TSH goal ranges increased with patient age (P < .001).
“Failure to recognize the relationship between age and thyroid hormone requirements may lead to overtreatment, especially in the elderly,” the researchers wrote. “Overtreatment with thyroid hormone replacement is common, and it can have negative effects, especially in older adults. We found that close to half of all physicians do not report patient age as an important factor when determining TSH goal, thus potentially placing older patients at risk for overtreatment.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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