Management practices among primary care physicians and thyroid specialistsin the care of hypothyroid patients

Prospective studies are not available to address various issues commonly en countered in the management of hypothyroid patients. We have conducted a ca se-based mail survey of American Thyroid Association (ATA) members and prim ary care providers (PCP) regarding hypothyroidism management issues. A majo rity of ATA members and a minority of PCPs used antithyroid antibody testin g in the evaluation of hypothyroidism. Approximately 2/3 of all respondents indicated that they would treat patients with mild thyroid failure when an tithyroid antibodies are negative; 77% of PCPs and 95% of ATA members recom mended treatment when antibodies are positive. For a young patient with mil d thyroid failure, 71% of ATA members would initiate a full levothyroxine ( LT4) replacement dose of 1.6 mug/kg per day or slightly lower; PCPs were mo re likely to start with a low dose and titrate upwards. For a young patient with overt hypothyroidism, 42% of PCPs and 51% of ATA respondents recommen ded an initial full LT4 replacement dose. The majority of all respondents w ould start with a low LT4 dose and adjust the dose gradually in an elderly patient, regardless of the severity of thyroid hormone deficiency. More tha n 40% of ATA respondents chose a target thyrotropin (TSH) range of 0.5-2.0 muU/mL for a young patient while 39% favored a goal of 1.0-4.0 muU/mL for a n elderly patient. PCPs more often chose a broader TSH goal of 0.5-5.0 muU/ mL. In conclusion, the current practice patterns of PCPs and ATA members th at were elicited in this survey differ significantly in regard to the evalu ation and management of hypothyroidism.