HEALTH NEWS

Study Title:

British Doctors Warn About Inappropriate Use of Thyroid Hormone Treatements

Study Abstract

Primary hypothyroidism or underactivity of the thyroid gland is common and is usually managed in primary care.1 In recent years, increasing numbers of patients with and without confirmed thyroid disease have been diagnosed and treated inappropriately using levothyroxine and other thyroid hormones. Management that falls outside good practice as defined nationally and internationally by accredited thyroid experts may compromise patients’ safety. This is potentially an enormous problem, given that in any one year one in four people in the United Kingdom have their thyroid function checked.

The Royal College of Physicians, working closely with several specialist professional associations and patient associations with interests in the safe management of thyroid diseases, has recently produced a statement on the diagnosis and management of primary hypothyroidism. This statement sets out clear guidance for general practitioners and the wider medical profession regarding the diagnosis and treatment of primary hypothyroidism in the United Kingdom.

So why have problems arisen regarding the diagnosis and treatment of hypothyroidism? The answer lies in the epidemiology and pathophysiology of this disease. Hypothyroidism is common and is becoming more prevalent because of increased life expectancy and an ageing population. Thyroid hormones affect most organs, so hypothyroidism presents with symptoms that can mimic other conditions. Although hypothyroidism may be missed and other conditions such as depression diagnosed instead, patients are increasingly being diagnosed with hypothyroidism in the absence of abnormal thyroid function tests.

An incorrect diagnosis of hypothyroidism could expose some patients to the harmful effects of excess thyroid hormones and other serious conditions may go undiagnosed.4 In other patients, adequate replacement with levothyroxine does not resolve symptoms, which are attributed to hypothyroidism rather than other conditions that may coexist, such as depression.

A plethora of information is available on the internet, and media interest in alternative modes of diagnosis and treatment of hypothyroidism is high. This has caused an increase in requests for inappropriate investigations and non-standard treatments, as well as referrals to non-accredited practitioners.3 4 These factors have led to a rise in awareness and confusion about hypothyroidism, and they have increased the workload in primary care.

In most cases the management of primary hypothyroidism is straightforward and should be undertaken in primary care. Secondary hypothyroidism is the result of pituitary disease and its treatment, and it should be managed only by specialist endocrinologists. Likewise, patients who take levothyroxine for thyroid cancer should be treated only in a specialist thyroid cancer clinic.

Normalisation of thyroid stimulating hormone means a return to normal health in most patients with primary hypothyroidism. If wellbeing is not restored despite normal concentrations of thyroid stimulating hormone, it is important to exclude other conditions as the cause of ongoing symptoms. If no obvious cause is found the patient should be referred to an accredited hospital endocrinologist or general physician.

Study Information

Amit Allahabadia, Salman Razvi, Prakash Abraham, and Jayne Franklyn.
Diagnosis and treatment of primary hypothyroidism.
British Medical Journal
2009 March
British Thyroid Association

Full Study

http://www.bmj.com/cgi/content/full/338/mar26_2/b725