Cómo tratamos en nuestra práctica clínica diaria el hipotiroidismo subclínico / How we treat subclinical hypothyroidism in our daily clinical practice

Objetivo. Estudiar el abordaje terapéutico del hipotiroidismo subclínico (HTS): frecuencia de instauración de tratamiento sustitutivo, motivos de inicio, dosis y duración, en la población mayor de 14 años del centro de salud. Material y métodos. Estudio observacional, longitudinal retrospectivo. Se incluyeron 1.156 pacientes con episodio T86 del CIAP en OMI. Excluidos: 10 duplicados, 180 sin criterios de inclusión o imposibilidad para recoger datos, 25 diagnosticados en otro laboratorio y 359 con hipotiroidismo clínico (HTC). Variables. Sexo, edad, cifra de hormona estimulante del tiroides (TSH) al diagnóstico y al iniciar tratamiento, última TSH recogida en la historia clínica (HC) si no tratado, TSH de confirmación diagnóstica, anticuerpos anti-TPO (ATA), presencia de astenia, bocio, síntomas neuropsiquiátricos, hipercolesterolemia; si hay HTS secundario; progresión a HTC; intervalo diagnóstico-inicio tratamiento, dosis de inicio y final, duración y motivos de la interrupción. Resultados. Se incluyeron 582 pacientes: 508 mujeres. Edad media: 43,03 (de 15,97). HTS tratado: 330 (56,7%); TSH al diagnóstico < 10: 81,6%; TSH media en tratados: 11,22 (de 10,49); ATA realizados: 315 (54%)+166 (52,7%); No consta recogido en HC. Astenia: 64%; bocio: 65%. El 67% no fueron tratados: normofunción espontánea. Dosis de inicio: 86% ≤ 50μg. Finales ≤ 50: 43%. Duración del tratamiento: 1-5 años, 41%; > 5 años, 40%. Inicio del tratamiento inmediato al diagnóstico, 38%. Permanecen tratados el 93%. Variables que aumentan la probabilidad de instauración de tratamiento (regresión logística): cifra TSH (OR 32,5; IC 12,8-82,6); ATA+(OR 4,7; IC 2,8-7,7); astenia (OR 2,5; IC 1,5-4); Bocio (OR 3; IC 1,3-6,6). Conclusiones. La decisión de tratar es generalmente adecuada, pero con frecuencia se cronifica un trastorno analítico instaurando tratamientos excesivamente prolongados sin intentos de retirada. Descuidamos la anamnesis y la exploración (AU)

Objective. To study the therapeutic approach to subclinical hypothyroidism (HTS), the frequency of introducing replacement therapy, reasons for starting, doses, and duration, in the population over 14 years-old in a Primary Care Centre. Material and methods. Longitudinal, retrospective observational study of 1156 patients with a hypothyroidism/myxedema episode (T86 in the International Classification of Primary Care (ICPC)) entered in the OMI program were studied. Excluded: 10 duplicates, 180 no inclusion criteria or inability to collect data, 25 diagnosed in another laboratory, 359 with clinical hypothyroidism (HTC). Measurements. Sex, age, TSH value to diagnosis and initiate treatment, or latest TSH recorded in the clinical history (HC) if not treated, TSH diagnostic confirmation, antiTPO antibodies (ATAs), presence of fatigue, goitre, neuropsychiatric symptoms, raised cholesterol, if HTS secondary, progression to HTC, diagnostic-start treatment interval, initial and final dose, duration, reasons for discontinuation. Results. 582 patients: 508 women. Mean age: 43.03 (sd 15.97). HTS treated: 330 (56.7%); TSH at diagnosis < 10: 81.6%; Mean TSH treated: 11.22 (sd 10.49); Made ATAs performed: 315 (54%),+166 (52.7%); Fatigue not recorded in HC: 64%; Goitre: 65%. 67% untreated: returned to normal spontaneously. Starting dose: 86% ≤ 50μg. Final ≤ 50: 43%. Treatment duration: 1-5 years 41%; > 5 years 40%. Immediate treatment after diagnosis 38%. Remain treated 93%. Variables that increase the likelihood of onset of treatment (Logistic Regression): TSH value (OR 32.5, CI 12.8- 82.6), ATAs+(OR 4.7, CI 2.8-7.7); Fatigue (OR 2.5, CI 1.5-4), Goitre (OR 3, CI 1.3-6.6). Conclusions. The decision to treat is generally adequate, but often becomes a chronic analytical disorder, because of unduly prolonged treatment without attempts to withdraw it. Clinical history and physical examination tend to be ignored (AU)

[How we treat subclinical hypothyroidism in our daily clinical practice]. / Cómo tratamos en nuestra práctica clínica diaria el hipotiroidismo subclínico.

OBJECTIVE: To study the therapeutic approach to subclinical hypothyroidism (HTS), the frequency of introducing replacement therapy, reasons for starting, doses, and duration, in the population over 14 years-old in a Primary Care Centre. MATERIAL AND METHODS: Longitudinal, retrospective observational study of 1156 patients with a hypothyroidism/myxedema episode (T86 in the International Classification of Primary Care (ICPC)) entered in the OMI program were studied. Excluded: 10 duplicates, 180 no inclusion criteria or inability to collect data, 25 diagnosed in another laboratory, 359 with clinical hypothyroidism (HTC). MEASUREMENTS: Sex, age, TSH value to diagnosis and initiate treatment, or latest TSH recorded in the clinical history (HC) if not treated, TSH diagnostic confirmation, antiTPO antibodies (ATAs), presence of fatigue, goitre, neuropsychiatric symptoms, raised cholesterol, if HTS secondary, progression to HTC, diagnostic-start treatment interval, initial and final dose, duration, reasons for discontinuation. RESULTS: 582 patients: 508 women. Mean age: 43.03 (sd 15.97). HTS treated: 330 (56.7%); TSH at diagnosis < 10: 81.6%; Mean TSH treated: 11.22 (sd 10.49); Made ATAs performed: 315 (54%),+166 (52.7%); Fatigue not recorded in HC: 64%; Goitre: 65%. 67% untreated: returned to normal spontaneously. Starting dose: 86% ≤ 50µg. Final ≤ 50: 43%. Treatment duration: 1-5 years 41%; > 5 years 40%. Immediate treatment after diagnosis 38%. Remain treated 93%. Variables that increase the likelihood of onset of treatment (Logistic Regression): TSH value (OR 32.5, CI 12.8- 82.6), ATAs+(OR 4.7, CI 2.8-7.7); Fatigue (OR 2.5, CI 1.5-4), Goitre (OR 3, CI 1.3-6.6). CONCLUSIONS: The decision to treat is generally adequate, but often becomes a chronic analytical disorder, because of unduly prolonged treatment without attempts to withdraw it. Clinical history and physical examination tend to be ignored.