Jonklaas Jacqueline, DeSale Sameer
Division of Endocrinology, Georgetown University, 4000 Reservoir Rd, NW, Bldg D Suite 230, Washington, DC, USA.
Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Washington, DC, USA.
Ther Adv Endocrinol Metab. 2020 Jul 2;11:2042018820937896. doi: 10.1177/2042018820937896. eCollection 2020.
Levothyroxine is a commonly prescribed medication. Some data suggest that levothyroxine may be initiated for mild degrees of hypothyroidism and used without considering age-specific reference ranges or individual patient factors when prescribing.
The electronic medical record of a health care system operating in the Washington, DC and Maryland area was interrogated to determine the number of patients who were being prescribed levothyroxine during the time period 2008-2016, the number of prescriptions supplied to these individuals, an associated diagnosis of hypothyroidism, and whether the prescriptions were new or existing prescriptions. Information was also extracted about the age of patients receiving prescriptions and the thyroid stimulating hormone level documented prior to levothyroxine initiation.
Although the number of levothyroxine prescriptions provided annually increased over this time period, when corrected for the number of patients in the database, the percentage of patients receiving levothyroxine prescriptions showed a slight downward trend. Levothyroxine was both most frequently prescribed and frequently initiated in those of ages 50-59 years and 60-69 years. The doses of levothyroxine most commonly prescribed were 50 µg and 100 µg and the pattern of levothyroxine doses being used was unaffected by whether a diagnosis of hypothyroidism was documented or not. Levothyroxine prescription initiation was associated with mean thyroid stimulating hormone values that were modestly elevated and in the range of 7.5-13.8 mIU/L.
This analysis showed that although the percentage of patients being prescribed levothyroxine is stable or slightly declining, with most decrement in those without a diagnosis of hypothyroidism, there is nevertheless continued initiation of levothyroxine in those with mild degrees of thyroid stimulating hormone elevation, and in those of older age, raising concerns about both unnecessary treatment and iatrogenic thyrotoxicosis. Such data suggest the need for great consideration of both the degree of thyroid stimulating hormone elevation and the patient context when considering whether treatment of an elevated thyroid stimulating hormone value, ongoing monitoring, is indicated.
左甲状腺素是一种常用药物。一些数据表明，对于轻度甲状腺功能减退症，可能会开始使用左甲状腺素，并且在开处方时未考虑特定年龄的参考范围或个体患者因素。
对在华盛顿特区和马里兰州地区运营的医疗保健系统的电子病历进行查询，以确定2008 - 2016年期间正在使用左甲状腺素的患者数量、提供给这些个体的处方数量、甲状腺功能减退症的相关诊断，以及这些处方是新处方还是现有处方。还提取了接受处方患者的年龄以及左甲状腺素开始使用前记录的促甲状腺激素水平的信息。
尽管在此期间每年提供的左甲状腺素处方数量有所增加，但校正数据库中的患者数量后，接受左甲状腺素处方的患者百分比呈轻微下降趋势。左甲状腺素在50 - 59岁和60 - 69岁人群中最常被处方且最常开始使用。最常开具的左甲状腺素剂量为50μg和100μg，左甲状腺素剂量的使用模式不受是否记录甲状腺功能减退症诊断的影响。左甲状腺素处方的开始与促甲状腺激素平均水平适度升高且在7.5 - 13.8 mIU/L范围内有关。
该分析表明，尽管开具左甲状腺素的患者百分比稳定或略有下降，未诊断为甲状腺功能减退症的患者下降最多，但促甲状腺激素轻度升高的患者以及老年患者仍在持续开始使用左甲状腺素，这引发了对不必要治疗和医源性甲状腺毒症的担忧。这些数据表明，在考虑是否需要治疗促甲状腺激素值升高以及是否需要进行持续监测时，需要充分考虑促甲状腺激素升高的程度和患者情况。
