Variation in treatment strategies of Swiss general practitioners for subclinical hypothyroidism in older adults.

QUESTIONS UNDER STUDY: As the best management of subclinical hypothyroidism is controversial, we aimed to assess variations in treatment strategies depending on different Swiss regions, physician and patient characteristics. METHODS: We performed a case-based survey among general practitioners (GPs) in different Swiss regions, which consisted of eight hypothetical cases presenting a female patient with subclinical hypothyroidism and nonspecific complaints differing by age, vitality status and thyroid-stimulating hormone (TSH) concentration. RESULTS: A total of 262 GPs participated in the survey. There was considerable variation in the levothyroxine starting dose chosen by GPs, ranging from 25 µg to 100 µg. Across the Swiss regions, GPs in the Bern region were significantly more inclined to treat, with a higher probability of initiating treatment (60%, p = 0.01) and higher mean starting doses (45 µg, p <0.01) compared with the French-speaking region (44%, 36 µg); the Zurich region had intermediate values (52%, 39 µg). We found no association between treatment rate and other physician characteristics. GPs were more reluctant to initiate treatment in 85-year-old than in 70-year-old women (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.63-0.94), and more likely to treat women with a TSH of 15 mU/l than those with a TSH of 6mU/l (OR 8.71, 95% CI 6.21-12.20). CONCLUSIONS: There are strong variations in treatment strategies for elderly patients with subclinical hypothyroidism across different Swiss regions, including use of higher starting doses than the recommended 25 µg in the Swiss guidelines, which recommend a starting dose of 25 µg. These variations likely reflect the current uncertainty about the benefits of treatment, which arise from the current lack of evidence from adequately powered clinical trials.

Karta öfver storfurstendömet Finland sammandragen, med stöd af de tillförlitligaste kartor uti general landtmäteri kontoret samt särskildte benäget meddelade upplysningar, uppå K. E. Holms förlag, af A. W. Eklund /

1 kartta :, vär. ;, lehti 88,7 x 58 cm

Karta öfver storfurstendömet Finland efter nya tillförlitliga källor och med särskildt begagnande af general stabens original-kartor utgiftven år 1860 af öfverste Georg Alfthan /

1 kartta :, vär. ;, 72,5 x 47,4 cm, lehti 83 x 58 cm

Kartor och beskrifningar öfver socknarne i Nylands län / upprättade å general landmäteri kontoret, lithografierade och utgifne till granskning och berigtigande år 1844.

1 kartasto ([35] s., [24] karttalehteä (7 taitettuina)) : 24 karttaa, vär. ; 56 cm

Post- och väg-karta öfver stor furstendömet Finland, med stöd af kartor utgifne af general landtmäteri contoiret, general staben, St Petersburgska postamtet, herrar Schubert, Ekelund, Brummer, von Knorring med flere och tillförlitligaste väga-uppgifter af alla storfurstendömets herrar gouverneurer samt enskilta bidrag utarbetad åren 1846 och 1848 af Berndt Ad. Lindeman postmästare

1 kartta :, vär. ;, 102 x 70 cm, [1:1231722], skalan är en million 231722 del af naturliga storleken

General charta til Sveriges sjö-atlas : andra delen

Graverad af Fr. Akrel

General charta til Sveriges sjö-atlas : första delen

Graverad af E. Åkerland

Mr [James] O'Grady arrivant à Caxton Hall [membre du Parlement anglais et secrétaire de la National Federation of General Workers] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 56233

[Portrait du] Major General [Charles Vere Ferrers] Townshend : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 59158

Etat general de la cituation de la citadelle de Perpignan

Ancien possesseur : Argenson, Antoine-René de Voyer (1722-1787 ; marquis de Paulmy d')

Major general John Lejeune : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 59974

« Inventoire general de tous les joyaulx... tant d'or comme d'argent... du roy Charles le Quint,... commancé le XXIme jour de janvier l'an mil troys cens soixante dix neuf ».

Commençant par : « C'est l'inventoire general du roy Charles le Quint de tous les joyaulx... » et finissant par : «... comme dessus d'un satanin bleu à broderie semé de menues perles. Laux Deo » .

« Inventoire general de tous les joyaulx... tant d'or comme d'argent... du roy Charles le Quint,... commancé le XXIme jour de janvier l'an mil troys cens soixante dix neuf ».

Commençant par : « C'est l'inventoire general du roy Charles le Quint de tous les joyaulx... » et finissant par : «... comme dessus d'un satanin bleu à broderie semé de menues perles. Laux Deo » .