Controversy Over the Diagnosis and Treatment of Hypothyroidism

Abstract

This study surveys clinicians’ hypothyroidism diagnosis and treatment practices and their opinions on current diagnostic standards. By distributing a redcap survey, the study ascertained whether practicing clinicians disagree with each other, where they stand on the debate over appropriate standards, and which standards they apply in practice. The survey garnered participants’ opinions on seven primary aspects of hypothyroidism: organizations’ differing recommendations, arguments for changing the standards, which thyroid hormones are worth testing, which ranges of thyroid hormones are appropriate, the psychosocial effects of the condition, their experience with clinical disagreements in practice, and their confidence in current standards. After asking for their opinions on these topics, participants were presented with nine fictional patient cases. Each patient case presented a fictional patient’s age, BMI, thyroid hormone levels, and symptoms. Participants were asked to indicate whether they were “very likely,” “likely,” “moderately,” “unlikely,” or “very unlikely” to diagnose the hypothetical patients. The survey was distributed to 750 healthcare providers, including endocrinologists, GPs, PAs, and NPs that practice in the United States. 48 practitioners responded. The results of the survey indicated that clinicians consistently and drastically disagree over diagnostic and treatment standards for hypothyroidism. Clinicians recommended testing for different hormones, indicated different healthy ranges of hormones, sided with opposing organizations, valued the psychosocial effects of the disease differently, and indicated varying levels of confidence in modern standards. Notably, practitioners’ likelihood of diagnosing and treating the fictional patients varied drastically. Qualitative responses provided the study with reasons for their answers. The qualitative results illustrated the polarizing nature of the disagreements; some practitioners deem clinicians of opposing opinions as committing “malpractice.” In conclusion, current standards are not unambiguous enough to create near-unanimous agreement among clinicians regarding the diagnostic threshold.