| Abstrakt: |
Key summary points: Aim: We aimed to evaluate the inappropriateness of the prescription of thyroid medication, and the inadequacy of control of thyroid dysfunction, in ambulatory patients aged 75 or over. Findings: Overall, inadequacy of control was found in 45.2% of patients with low thyrotropin (TSH) and 6.93% of those with high serum TSH. Our data also indicate that 39.7% and 27.5% of patients with low and high serum TSH, respectively, are inadequately treated. The main cause of this inadequate treatment is the prescription of levothyroxine with TSH values < 10 mU/l. Message: We suggest that clinicians should make efforts to align their thyroid prescriptions to current guidelines and closely monitor thyroid function tests in older people. Purpose: Suboptimal control of thyroid dysfunction may carry harmful health consequences, especially in older population. We aimed to estimate the inadequacy of thyroid dysfunction treatment and control in people aged 75 years and over. Methods: A cross-sectional analysis of all serum thyrotropin (TSH) determinations carried out by the Biochemistry laboratory of the Hospital Universitario Puerta de Hierro Majadahonda during 2019 was performed. All samples from outpatients over age 75 years were selected. In patients with serum TSH out of the range of reference (0.35–5.0 mU/l), we calculated the proportions of patients with inadequate control and inadequate treatment. Results: Of a total of 15,255 patients (mean (SD) age, 82.9 ± 6.1 years; 62.1% females), 13,796 had normal serum TSH (82.8 ± 6.1 years; 61.1% females), 398 low TSH (83.3 ± 6.7 years; 75.6% females), and 1061 high TSH (83.0 ± 4.0 years; 69.5% females). Inadequate control of thyroid function was found in 45.2% (95% CI 40.0–51.0) of patients with low TSH and in 6.93% (95% CI 5.40–8.85) of patients with high TSH. Furthermore, 39.7% (95% CI 34.1–45.6) of patients with low TSH and 27.5% (95% CI 24.5–30.6) of patients with high TSH were not adequately treated. Inadequacy of control was higher in women and patients over 82 years with elevated TSH. Inadequacy of therapy was higher in women. Conclusions: Inadequacy in both treatment and control of thyroid dysfunction is found in a significant number of aged patients. Clinicians should strive to improve thyroid medication prescription and closely monitor older patients with thyroid dysfunction. [ABSTRACT FROM AUTHOR] |
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