HealthMetrics Outcomes Research LLC, 27576 River Reach Drive, Bonita Springs, FL, 34134, USA.
AbbVie, Inc., 26525 North Riverwoods Boulevard, North Chicago, IL, 60045, USA.
Adv Ther. 2020 May;37(5):2275-2287. doi: 10.1007/s12325-020-01296-z. Epub 2020 Apr 11.
Hypothyroidism is a common but often unrecognized condition associated with significant morbidity in the older adult population. This study characterizes a large population of older adults diagnosed with hypothyroidism and examines concordance of their treatment with recommendations from expert bodies, e.g., the American Thyroid Association and American Association of Clinical Endocrinologists.
Individuals seen in general and/or specialty practices who were age ≥ 65 years and diagnosed with hypothyroidism were included in this observational, retrospective cohort study using a large US claims database. Analyses describe the population and examine the prevalence of hypothyroidism, treatment with levothyroxine and, among those treated, whether TSH laboratory values are within a guideline-recommended target range.
Prevalence of hypothyroidism in this older adult population increased from 5.62% to 8.24% over the 2007-2015 period. Among older adults diagnosed with hypothyroidism (N = 4025), a substantial proportion (28.0%) did not receive levothyroxine therapy, and, of those who were receiving such therapy (N = 2899), 32.9% did not have evidence of being monitored to determine whether the dosage was appropriate. Moreover, the laboratory results of those who were treated suggest that a significant proportion (17.4%) had a TSH level above the recommended target range, while TSH levels for a smaller proportion (3.7%) were below target.
Many older adults diagnosed with hypothyroidism may not have received medical care complying with clinical practice guidelines. Results of this study reveal a number of areas to target to potentially improve the treatment of older adults with hypothyroidism.
甲状腺功能减退症是一种常见但常被忽视的疾病，在老年人群中与显著发病率相关。本研究描述了大量被诊断为甲状腺功能减退症的老年患者人群，并检查了他们的治疗是否与美国甲状腺协会和美国临床内分泌医师协会等专家机构的建议一致。
本观察性回顾性队列研究使用大型美国索赔数据库，纳入了在一般和/或专科诊所就诊、年龄≥65 岁且被诊断为甲状腺功能减退症的患者。分析描述了人群，并检查了甲状腺功能减退症的患病率、左甲状腺素治疗情况，以及在接受治疗的患者中，促甲状腺激素（TSH）实验室值是否在指南推荐的目标范围内。
在该老年人群中，甲状腺功能减退症的患病率从 2007 年至 2015 年期间从 5.62%增加到 8.24%。在被诊断为甲状腺功能减退症的老年患者（N=4025）中，相当一部分（28.0%）未接受左甲状腺素治疗，而在接受治疗的患者（N=2899）中，有 32.9%的患者没有进行监测以确定剂量是否合适。此外，接受治疗的患者的实验室结果表明，相当一部分（17.4%）的 TSH 水平高于推荐的目标范围，而小部分（3.7%）的 TSH 水平低于目标范围。
许多被诊断为甲状腺功能减退症的老年患者可能没有接受符合临床实践指南的医疗护理。本研究的结果揭示了一些潜在的领域，以改善老年甲状腺功能减退症患者的治疗。
