TY - JOUR
T1 - The Effects of Patient Characteristics on the Management of Subclinical Hypothyroidism
T2 - A Survey of Faculty and Trainees
AU - Jiang, Cherry
AU - Wolf, Katherine
AU - Kaakati, Rayan
AU - Oh, Jessica
AU - Yip, Allison T.
AU - Jonklaas, Jacqueline
AU - Bianco, Antonio C.
AU - Laiteerapong, Neda
AU - Ettleson, Matthew D.
N1 - Publisher Copyright:
© 2023 AACE
PY - 2023/10
Y1 - 2023/10
N2 - Objective: There is no universal approach to the management of subclinical hypothyroidism (SCH). This study was designed to determine the impact of patient characteristics on management decisions in SCH amongst physician faculty members and trainees. Methods: An online survey was distributed to faculty members and medical trainees (ie, interns, residents, and fellows) at multiple academic medical centers. The survey included 9 clinical scenarios describing women with SCH with 5 management options sequenced from most “conservative” (no further treatment or monitoring) to most “aggressive” (treatment with levothyroxine). Results: Of the 194 survey respondents, 95 (49.0%) were faculty members and 99 (51.0%) were trainees. Faculty members were more likely to report being “confident” or “very confident” in making the diagnosis of SCH compared to trainees (95.8% vs 46.5%, P <.001). Faculty members were also more likely to consider patient preference for treatment (60.0% vs 32.3%, P <.001). Among all respondents, the clinical factors that resulted in the highest predicted probability of treatment were hypothyroid symptoms (predicted probability [PP] 68.8%, 95% CI [65.7%-71.9%]), thyroid stimulating hormone >10 mIU/L in a 31-year-old (PP 63.9%, 95% CI [60.3%-67.3%]), and the desire for fertility (PP 52.2%, 95% CI [48.6%-56.0%]). In general, faculty members favored more aggressive treatment across all clinical scenarios. Conclusion: The presence of symptoms, thyroid stimulating hormone >10 mIU/L, and desire for fertility were most predictive of the decision to treat in SCH. In several clinical scenarios, both trainee and faculty decision-making demonstrated discordance with general SCH management principles.
AB - Objective: There is no universal approach to the management of subclinical hypothyroidism (SCH). This study was designed to determine the impact of patient characteristics on management decisions in SCH amongst physician faculty members and trainees. Methods: An online survey was distributed to faculty members and medical trainees (ie, interns, residents, and fellows) at multiple academic medical centers. The survey included 9 clinical scenarios describing women with SCH with 5 management options sequenced from most “conservative” (no further treatment or monitoring) to most “aggressive” (treatment with levothyroxine). Results: Of the 194 survey respondents, 95 (49.0%) were faculty members and 99 (51.0%) were trainees. Faculty members were more likely to report being “confident” or “very confident” in making the diagnosis of SCH compared to trainees (95.8% vs 46.5%, P <.001). Faculty members were also more likely to consider patient preference for treatment (60.0% vs 32.3%, P <.001). Among all respondents, the clinical factors that resulted in the highest predicted probability of treatment were hypothyroid symptoms (predicted probability [PP] 68.8%, 95% CI [65.7%-71.9%]), thyroid stimulating hormone >10 mIU/L in a 31-year-old (PP 63.9%, 95% CI [60.3%-67.3%]), and the desire for fertility (PP 52.2%, 95% CI [48.6%-56.0%]). In general, faculty members favored more aggressive treatment across all clinical scenarios. Conclusion: The presence of symptoms, thyroid stimulating hormone >10 mIU/L, and desire for fertility were most predictive of the decision to treat in SCH. In several clinical scenarios, both trainee and faculty decision-making demonstrated discordance with general SCH management principles.
KW - clinical decision-making
KW - medical education
KW - subclinical hypothyroidism
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U2 - 10.1016/j.eprac.2023.07.031
DO - 10.1016/j.eprac.2023.07.031
M3 - Article
C2 - 37549880
AN - SCOPUS:85170225349
SN - 1530-891X
VL - 29
SP - 787
EP - 793
JO - Endocrine Practice
JF - Endocrine Practice
IS - 10
ER -