The reality of subclinical hypothyroidism in general practice

Abstract

INTRODUCTION: Subclinical hypothyroidism (SCH) is common, reported to affect 4–10% of the adult population. Recommendations for treatment of SCH are contentious, with protagonists even disagreeing over the rationale for medical intervention. How general practitioners (GPs) manage patients with elevated thyroid stimulating hormone (TSH) and normal thyroid hormone results are unknown. This study aimed to explore how GPs think about diagnosing and managing SCH. METHODS: A qualitative study using focus groups conducted between December 2007 and March 2008 to understand how GPs perceive SCH and their diagnostic and management process. FINDINGS: Thirteen GPs in three focus groups in Waikato, New Zealand participated. There is wide variability in how GPs perceive SCH and their knowledge of the disease. A patient-centred approach to diagnosis and management was commonly reported. Consideration of overt pathology and medicolegal issues also influenced perceptions of SCH, but lack of evidence regarding outcomes of treatment made such issues complex. CONCLUSION: SCH remains a complex entity because of ambiguity regarding symptoms, uncertainty regarding prognosis and variation in advice regarding treatment. This complexity is reflected in the disparate responses by GPs to the diagnosis and management of SCH. KEYWORDS: Hypothyroidism; family practice; qualitative research