TY - JOUR
T1 - Determinants for Thyroid Hormone Replacement Therapy in Subclinical Hypothyroidism
T2 - A Multicenter Electronic Health Records-Based Study
AU - Toloza, Freddy J.K.
AU - El Kawkgi, Omar M.
AU - Spencer, Horace J.
AU - Mathews, Sherin Elsa
AU - Garcia, Andrea
AU - Gamboa, Augusto
AU - Mirza, Nabeel
AU - Mohan, Sneha
AU - Vallejo, Sebastian
AU - Bogojevic, Marija
AU - Rodriguez-Gutierrez, Rene
AU - Ospina, Naykky M.Singh
AU - Brito, Juan P.
AU - Maraka, Spyridoula
N1 - Publisher Copyright:
© 2023 Mary Ann Liebert, Inc.
PY - 2023/9/1
Y1 - 2023/9/1
N2 - Background: The frequency and factors associated with thyroid hormone replacement therapy among patients with subclinical hypothyroidism (SCH) remain uncertain. Methods: In this electronic health records-based observational cohort study, we included adults diagnosed with SCH from four academic centers (the United States and Mexico) from January 1, 2016, to December 31, 2018. We aimed to identify the determinants of thyroid hormone replacement therapy for SCH and the frequency of treated SCH. Results: A total of 796 patients (65.2% women) had SCH, and 165 (20.7%) were treated with thyroid hormone replacement therapy. The treated group was younger [51.0 (standard deviation {SD} 18.3) vs. 55.3 (SD 18.2) years, p = 0.008] and had a higher proportion of women (72.7% vs. 63.2%, p = 0.03) compared with the untreated group. Only 46.7% of patients in the treated group and 65.6% in the untreated group had confirmatory thyroid function tests (TFTs) before the decision to start thyroid hormone replacement therapy was made. There was no difference in the frequency of thyroid autoimmunity evaluation, but a positive thyroid autoimmunity test was more frequent in the treated group compared with the untreated group (48.2% vs. 20.3%, p < 0.001). In a multivariable logistic regression model, female sex (odds ratio [OR] = 1.71 [CI 1.13–2.59], p = 0.01) and index thyrotropin (TSH) level (OR = 1.97 [CI 1.56–2.49], p < 0.001 for every SD [2.75 mIU/L] change) were associated with higher odds of treatment. Conclusions: Among patients with SCH, female sex and index TSH level were associated with higher odds of treatment. Moreover, in our population, the decision to treat or not to treat SCH was often based on only one set of abnormal TFTs, and thyroid autoimmunity assessment was underused.
AB - Background: The frequency and factors associated with thyroid hormone replacement therapy among patients with subclinical hypothyroidism (SCH) remain uncertain. Methods: In this electronic health records-based observational cohort study, we included adults diagnosed with SCH from four academic centers (the United States and Mexico) from January 1, 2016, to December 31, 2018. We aimed to identify the determinants of thyroid hormone replacement therapy for SCH and the frequency of treated SCH. Results: A total of 796 patients (65.2% women) had SCH, and 165 (20.7%) were treated with thyroid hormone replacement therapy. The treated group was younger [51.0 (standard deviation {SD} 18.3) vs. 55.3 (SD 18.2) years, p = 0.008] and had a higher proportion of women (72.7% vs. 63.2%, p = 0.03) compared with the untreated group. Only 46.7% of patients in the treated group and 65.6% in the untreated group had confirmatory thyroid function tests (TFTs) before the decision to start thyroid hormone replacement therapy was made. There was no difference in the frequency of thyroid autoimmunity evaluation, but a positive thyroid autoimmunity test was more frequent in the treated group compared with the untreated group (48.2% vs. 20.3%, p < 0.001). In a multivariable logistic regression model, female sex (odds ratio [OR] = 1.71 [CI 1.13–2.59], p = 0.01) and index thyrotropin (TSH) level (OR = 1.97 [CI 1.56–2.49], p < 0.001 for every SD [2.75 mIU/L] change) were associated with higher odds of treatment. Conclusions: Among patients with SCH, female sex and index TSH level were associated with higher odds of treatment. Moreover, in our population, the decision to treat or not to treat SCH was often based on only one set of abnormal TFTs, and thyroid autoimmunity assessment was underused.
KW - autoimmunity
KW - levothyroxine
KW - subclinical hypothyroidism
KW - thyroid
UR - http://www.scopus.com/inward/record.url?scp=85171393233&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85171393233&partnerID=8YFLogxK
U2 - 10.1089/thy.2023.0062
DO - 10.1089/thy.2023.0062
M3 - Article
C2 - 37279296
AN - SCOPUS:85171393233
SN - 1050-7256
VL - 33
SP - 1045
EP - 1054
JO - Thyroid
JF - Thyroid
IS - 9
ER -