Clinical practice pattern in the management of hypothyroidism among Indian Doctors – A questionnaire-based cross-sectional survey
DOI:
https://doi.org/10.37506/1k6xwa42Keywords:
Hypothyroidism, subclinical hypothyroidism, hypothyroidism during pregnancy, clinical practice, guidelines, pattern, trend.Abstract
Background: Hypothyroidism is a chronic disease, affecting almost all body functions, associated with deficiency in the thyroid hormones T4 and T3. Though different clinical practice guidelines available, but lots of inconsistency still exists in treatment practices by different physicians across different specialties. This study was conducted with an aim to document and report current clinical practices for managing hypothyroidism.
Materials & Methods: A cross-sectional survey was conducted in 30 practicing doctors including family physicians/general practitioners /primary care physicians, endocrinologists and doctors of other specialties practicing in and around Kolkata, West Bengal, India. Pre-designed validated questionnaire was used after necessary modification in view of pilot study to evaluate the clinical practice patterns for managing hypothyroidism in this study. Results: About 36.67% of participating doctors were practicing gradual restoration of euthyroidism, whereas 26.67% were of the opinion to prescribe an empiric dose and there after adjusting the dose to achieve target thyroid hormone levels and 36.67% agreed that they would start with a calculated full-replacement dose from the beginning. About 54% would increase in increments of 25 microgram during gradual restoration of euthyroidism. Approx. 90% would use a brand name of L-T4. 45% would recheck thyroid hormone levels 6 weeks after starting therapy and 56% would obtain laboratory studies at 3-month intervals. In patient planning pregnancy, the preferred TSH target was 1.0 to 1.4 mU/L (40%) while 60% would continue the current dose of LT4 during pregnancy. In subclinical hypothyroidism, positive TPO antibodies and symptoms of hypothyroidism constitute the main determinants for initiating treatment.
Conclusion: The survey revealed both alignment and focal deviation from recent Clinical practice guidelines.
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