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CC BY-NC-ND 4.0 · Journal of Diabetes and Endocrine Practice 2024; 07(03): 135-144
DOI: 10.1055/s-0044-1789211
Original Article

Impact of Patient Age on Management of Hypothyroidism: A Survey of Physicians from Three Developing Regions

Authors

  • Salem A. Beshyah 

    1   Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates

  • Mohammed Bashir

    2   Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar

  • Khadija Hafidh 

    3   Department of Endocrinology, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates

  • Bachar Afandi

    4   Division of Endocrine, Tawam Hospital, Al Ain, United Arab Emirates
    5   Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, United Arab Emirates

  • Shehla Shaikh

    6   K G N Diabetes & Endocrinology Centre, Mumbai, Maharashtra, India

  • Sonia Hammami

    7   Department of Internal Medicine, CHU F Bourguiba Monastir, Geriatric Unit, Monastir, Tunisia

  • Ali B. Khalil 

    5   Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, United Arab Emirates
    8   Department of Endocrinology, Reem Hospital, Abu Dhabi, United Arab Emirates
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Abstract

Background The thyroid-stimulating hormone (TSH) levels increase with age, and aiming for the same TSH target applicable in a younger population in older patients who are on replacement with thyroid hormones.

Methods We assessed practice patterns regarding TSH goals and explored factors influencing physicians' decision-making when managing hypothyroidism. Multiple-choice questions in a case-based survey of a convenience sample of physicians practicing in relevant disciplines in three developing regions.

Results Of the total 286, senior physicians represented 63% and mid-grades represented 27% of the respondents. Forty-one percent were endocrinologists, 19% were internists with endocrine interests, and 16% were family physicians. Over half (52%) practiced at a tertiary level and 42% had been in practice for over 20 years. Fifty percent of respondents had more than 20% of their patients over 65 years.

Several attributes were factored into decision-making when managing hypothyroidism. Respondents took into account age (75%), preceded by the presence of cardiac arrhythmias (80%), pregnancy (79%), heart disease (78%), and patient symptoms (77%) when determining the treatment strategy. When presented with scenarios differing in patients' age, around 90% of physicians targeted a TSH ≤ 3.0 mIU/L in 30-year-old patients. Fifteen percent of respondents targeted a TSH of 1.6 to 3.0 mIU/L in octogenarians, but 78% targeted a TSH > 3.1 to 5.0 mIU/L in this group. Regardless of sex, physician-reported TSH goal ranges (0.1–0.5, 0.6–1.5, 1.6–3.0, and 3.1–5.0 mIU/L) increased directly to patient age. Overall, respondents were less inclined to start treatment in 85-year-olds than in 70-year-old females with TSH of 6 mU/L (20% vs. 11%). Females with a TSH of 15 mU/L were more likely to get treated than those with a 6 mU/L TSH. Vital persons are more likely to be treated with thyroxine than vulnerable persons for the same TSH levels. Multivariate analysis showed that compared with endocrinologists, family physicians and other specialties were less likely to consider age in their clinical decisions, odds ratio (OR) 0.2 (95% confidence interval [CI] 0.1–0.7), p = 0.018, and OR 0.3 (95% CI 0.1–0.8), p = 0.013, respectively.

Conclusion A consensus is needed on the role of patients' age in hypothyroidism management, the complexity of managing hypothyroidism in an older adult patient, and the variability in practice patterns among physicians. Addressing these challenges demands ongoing dialogue and collaboration among health care providers to improve patient care and outcomes in hypothyroidism management across different age groups.

Keywords

older adults - hypothyroidism - survey - thyroid hormone therapy - overtreatment - age

Compliance with Ethical Standards

The Institutional Review Board of Sheikh Khalifa Medical City, Abu Dhabi, UAE, approved the study. Before accessing the survey questions, all participants provided electronic informed consent. All data were analyzed anonymously.


Authors' Contributions

S.A.B. proposed the study, adapted the questionnaire, and managed the survey process. All authors examined the data, revised the manuscript for intellectual content and presentation, and approved its final version.


Supplementary Material



Publication History

Article published online:
26 August 2024

© 2024. Gulf Association of Endocrinology and Diabetes (GAED). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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