Controversy Over the Diagnosis and Treatment of Hypothyroidism
Schwartz, Lana
:
2021-04
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.