Back to Search
Start Over
Variation in Treatment Practices for Subclinical Hypothyroidism in Pregnancy: US National Assessment
- Publication Year :
- 2019
- Publisher :
- Endocrine Society, 2019.
-
Abstract
- CONTEXT: Although thyroid hormone replacement may improve outcomes in pregnant women with subclinical hypothyroidism (SCH), the extent to which they receive treatment is unknown. OBJECTIVE: To describe levothyroxine (LT(4)) treatment practices for pregnant women with SCH. DESIGN: Retrospective cohort study. SETTING: Large US administrative claims database. PARTICIPANTS: Pregnant women with SCH defined by untreated TSH 2.5 to 10 mIU/L. MAIN OUTCOME MEASURE: Initiation of LT(4) as a function of treating clinician specialty (endocrinology, obstetrics/gynecology, primary care, or other), baseline TSH, patient clinical and demographic factors, and US region. RESULTS: We identified 7990 pregnant women with SCH; only 1214 (15.2%) received LT(4). Treatment was more likely in patients with higher TSH, obesity, recurrent pregnancy loss, thyroid disease, and cared for by endocrinologists. Proportion of treated women increased over time; LT(4) treatment was twice as likely in 2014 as in 2010. Women in Northeast and West US were more likely to receive LT(4) compared with other regions. Asian women were more likely, whereas Hispanic women were less likely, to receive LT(4) compared with white women. Endocrinologists started LT(4) at lower TSH thresholds than other specialties, and treated women who were more likely to have had recurrent pregnancy loss and thyroid disease than women treated by other clinicians. CONCLUSIONS: We found large variation in the prescription of LT(4) to pregnant women with SCH, although most treatment-eligible women remained untreated. Therapy initiation is associated with geographic, clinician, and patient characteristics. This evidence can inform quality improvement efforts to optimize care for pregnant women with SCH.
- Subjects :
- endocrine system
medicine.medical_specialty
Endocrinology, Diabetes and Metabolism
Clinical Biochemistry
Levothyroxine
030209 endocrinology & metabolism
Context (language use)
Biochemistry
03 medical and health sciences
0302 clinical medicine
Endocrinology
Internal medicine
medicine
030212 general & internal medicine
Medical prescription
Clinical Research Articles
Subclinical infection
Pregnancy
Obstetrics
business.industry
Thyroid disease
Biochemistry (medical)
Thyroid
Retrospective cohort study
medicine.disease
medicine.anatomical_structure
business
medicine.drug
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....b0b9f5383fd5b979cb2f6e4b1f7035c8