Terlea Andreea, Toloza Freddy J K, Owen Richard R, Williams James S, Knox Micheal, Dishongh Katherine, Thostenson Jeff D, Singh Ospina Naykky M, Brito Juan P, Maraka Spyridoula
Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA.
Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
J Clin Med. 2024 Sep 26;13(19):5727. doi: 10.3390/jcm13195727.
There is evidence of overtreatment in patients with subclinical hypothyroidism (SCH). We aimed to identify the proportion of patients treated for SCH and the determinants of thyroid hormone therapy initiation. We included a random sample of adult Veterans diagnosed with SCH from 1 January 2016 to 31 December 2018 and conducted univariate and multivariable logistic regression to identify factors associated with levothyroxine initiation. Out of 229 Veterans with SCH [90.0% male, 87.2% White, 99.1% non-Hispanic, median age (interquartile range; IQR) 68 (17) years], 27.5% were treated with levothyroxine. The treated group had a higher proportion of White patients (95.2% vs. 84.2%, = 0.039), a higher thyrotropin level [median (IQR), 6.98 (2.06) mIU/L vs. 6.14 (1.10) mIU/L, = 0.0002], a higher proportion of patients with thyrotropin level ≥ 10 mIU/L (11.1% vs. 3.0%, = 0.021), a lower frequency of confirmatory thyroid testing before initiating levothyroxine (49.2% vs. 97.0%, < 0.0001), and a similar frequency of thyroid autoimmunity testing (3.2% vs. 0.6%, = 0.18) compared to the untreated group. In a multivariable logistic regression analysis, White race (OR = 4.50, 95% CI 1.19 to 17.08, = 0.026) and index thyrotropin level [OR = 1.71, 95% CI 1.24 to 2.35, = 0.001; for every SD increase (1.6 mIU/L)] were associated with higher odds of treatment. Three in 10 Veterans with SCH received levothyroxine, often based on a single abnormal thyroid test without autoimmunity assessment. White race and higher thyrotropin level were linked to increased odds of starting treatment, indicating potential disparities and the influence of SCH severity on decision-making.
有证据表明亚临床甲状腺功能减退症（SCH）患者存在过度治疗的情况。我们旨在确定接受SCH治疗的患者比例以及启动甲状腺激素治疗的决定因素。我们纳入了2016年1月1日至2018年12月31日期间被诊断为SCH的成年退伍军人的随机样本，并进行单变量和多变量逻辑回归分析以确定与左甲状腺素启动相关的因素。在229名患有SCH的退伍军人中（男性占90.0%，白人占87.2%，非西班牙裔占99.1%，年龄中位数[四分位间距；IQR]为68[17]岁），27.5%接受了左甲状腺素治疗。治疗组白人患者比例更高（95.2%对84.2%，P = 0.039），促甲状腺激素水平更高[中位数（IQR），6.98（2.06）mIU/L对6.14（1.10）mIU/L，P = 0.0002]，促甲状腺激素水平≥10 mIU/L的患者比例更高（11.1%对3.0%，P = 0.021），启动左甲状腺素治疗前进行甲状腺确认检测的频率更低（49.2%对97.0%，P < 0.0001），与未治疗组相比，甲状腺自身免疫检测频率相似（3.2%对0.6%，P = 0.18）。在多变量逻辑回归分析中，白人种族（比值比[OR]=4.50，95%置信区间[CI]为1.19至17.08，P = 0.026）和初始促甲状腺激素水平[OR = 1.71，95%CI为1.24至2.35，P = 0.001；每增加1个标准差（1.6 mIU/L）]与更高的治疗几率相关。每10名患有SCH的退伍军人中有3人接受了左甲状腺素治疗，通常基于单次异常甲状腺检测且未进行自身免疫评估。白人种族和更高的促甲状腺激素水平与开始治疗的几率增加有关，表明存在潜在差异以及SCH严重程度对决策的影响。
