Elevated Thyroid Stimulating Hormone (TSH) Levels: A Database Study of General Practitioners’ Course of Action
Authors' conclusion
While the degree of thyroid dysfunction was the main driver of follow-up, we identified important gaps in the primary care-based monitoring of elevated TSH levels in young patients and in patients with infrequent consultations. We also observed potential overtreatment of women and patients in nonurban areas. Our findings highlight the need for standardization and dissemination of guidelines for the management of elevated TSH levels among general practitioners.
Study context
- Population
- Adults without prior thyroid disease with a first elevated TSH, Jan 2015–Dec 2020, Swiss primary care database; median age 65 years, 64.4% female, median TSH 5.7 mIU/L
- Participants
- 1,591 adults
- Outcome
- Repeat TSH testing or direct levothyroxine initiation in primary care
- Follow-up
- 12-month follow-up
Methodological detailsprimary care database, electronic medical records
- Primary care database
- Electronic medical records
Main finding
As reported in the abstract
Repeat TSH testing
34.3%
Direct levothyroxine replacement
12.4%
Observational data: associations, not effects.
Further findings
Factors associated with repeat TSH testing
- Strongest association with overt hypothyroidism; more common with high primary care utilization and in patients aged 40-64 vs <40 years
Factors associated with direct levothyroxine initiation
- More likely for TSH >7 mIU/L, overt hypothyroidism, female patients and nonurban practices
Original publication
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