Surana Vineet, Aggarwal Sameer, Khandelwal Deepak, Singla Rajiv, Bhattacharya Saptarshi, Chittawar Sachin, Kalra Sanjay, Dutta Deep
Department of Endocrinology, Paras Hospitals, Gurgaon, Haryana, India.
Department of Medicine, Division of Endocrinology, Pandit Bhagwat Dayal Sharma Post-Graduate Institute of Medical Sciences, Karnal, Haryana, India.
Indian J Endocrinol Metab. 2017 Jan-Feb;21(1):165-177. doi: 10.4103/2230-8210.196012.
This study aimed to document practices in managing hypothyroidism among doctors in New Delhi, with special focus on subclinical hypothyroidism, pregnancy, and old age, and to compare it with global practices.
During an academic program attended by 394 doctors, all participants were given a questionnaire designed based on thyroid practices survey done by Burch . to evaluate the practice patterns. Questions were based on evaluating doctor's preferred choices in diagnosis, therapy, and follow-up of hypothyroidism in different scenarios.
Responses from 308 questionnaires (general physicians [ = 204], obstetricians [ = 51], pediatricians [ = 27], surgeons [ = 12], endocrinologists [ = 10], and others [ = 4]) were analyzed. In the evaluation of 52-year-old female patient with primary hypothyroidism, 52% doctors would prefer thyroid ultrasonography, comparable to global rates. Nearly 96.1% doctors would have initiated levothyroxine, with a large majority of doctors (83.77%) preferred using branded levothyroxine. About 58.74% doctors preferred gradual restoration of euthyroidism. Levothyroxine dose of 25 mcg was the most preferred increment dose (46.07%) during follow-up, with 6 weekly being the most frequent dose adjustment frequency (41.57%). Most preferred target thyroid-stimulating hormone (TSH) in the 52-year-old female patient was 2.5-4.99 mU/L (63.96%), 25-year-old female patient was 1-2.49 mU/L (53.90%), and in 85-year-old female was 2.5-4.99 mU/L (45.45%). Only 68% of doctors in our study preferred keeping TSH <2.5 mU/L during the first trimester of pregnancy, in contrast to global trends of 95% ( < 0.001).
There was a disproportionately high use of ultrasonography in hypothyroidism management, near exclusive preference for branded levothyroxine, widespread use of age-specific TSH targets, and low threshold for treating mild thyroid failure, a highly variable approach to both rates and means of restoring euthyroidism for overt primary hypothyroidism. There is a need for spreading awareness regarding TSH targets in pregnancy.
本研究旨在记录新德里医生管理甲状腺功能减退症的实践情况，特别关注亚临床甲状腺功能减退症、妊娠和老年患者，并与全球实践情况进行比较。
在一个有394名医生参加的学术项目中，所有参与者都收到了一份基于伯奇所做的甲状腺实践调查设计的问卷，以评估实践模式。问题基于评估医生在不同情况下对甲状腺功能减退症的诊断、治疗和随访的首选。
分析了308份问卷的回复（普通内科医生[ = 204]、产科医生[ = 51]、儿科医生[ = 27]、外科医生[ = 12]、内分泌科医生[ = 10]和其他[ = 4]）。在评估一名52岁的原发性甲状腺功能减退症女性患者时，52%的医生会首选甲状腺超声检查，与全球比例相当。近96.1%的医生会开始使用左甲状腺素，绝大多数医生（83.77%）更喜欢使用品牌左甲状腺素。约58.74%的医生更喜欢逐步恢复甲状腺功能正常。在随访期间，25微克的左甲状腺素剂量是最首选的增量剂量（46.07%），每6周是最频繁的剂量调整频率（41.57%）。52岁女性患者最首选的目标促甲状腺激素（TSH）是2.5 - 4.99毫国际单位/升（63.96%），25岁女性患者是1 - 2.49毫国际单位/升（53.90%），85岁女性是2.5 - 4.99毫国际单位/升（45.45%）。在我们的研究中，只有68%的医生在妊娠早期更喜欢将TSH维持在<2.5毫国际单位/升，而全球趋势为95%（<0.001）。
在甲状腺功能减退症管理中，超声检查的使用比例过高，几乎完全倾向于品牌左甲状腺素，广泛使用特定年龄的TSH目标，治疗轻度甲状腺功能减退的阈值较低，对于显性原发性甲状腺功能减退症恢复甲状腺功能正常的速度和方法存在高度可变的方法。有必要提高对妊娠期间TSH目标的认识。
