MON-599 Physician Reported Challenges in the Management of Hypothyroidism

Introduction: Thyroid hormone use is widespread and levothyroxine is one of the most commonly prescribed medications in the United States. Although prior research has focused on over- and undertreatment and patient dissatisfaction with thyroid hormone replacement, little is known about physician reported barriers to managing thyroid hormone replacement in patients. Methods: We surveyed physician members of the Endocrine Society, the American Academy of Family Practice and the American Geriatrics Society using the modified Dillman method of survey administration. Respondents were asked to rate barriers to the management of thyroid hormone therapy. As patient requests for tests and treatments was a highly ranked barrier, we conducted a multivariable analysis to determine correlates with physician report of patient requests as a barrier. Results: The survey response rate was 63% (359/566). Patient non-compliance (70%), patient requests for tests and treatments (46%) and multiple providers managing thyroid hormone replacement (45%) were reported as somewhat to very likely barriers to the management of thyroid hormone therapy. Endocrinologists (p=0.045) and physicians with high case volume (p=0.035) were more likely to report patient requests for tests and treatments as a barrier, whereas physicians with more years in practice were less likely to do so (11-20 years: p=0.025; >20 years: p<0.001). Common patient requests reported by surveyed physicians included requests for preparations other than synthetic thyroxine (52%), adjusting thyroid hormone dose based on symptoms when biochemically euthyroid (52%), maintaining thyroid stimulating hormone (TSH) below normal range (32%) and adjusting thyroid hormone dose according to serum T3 level (21%). Conclusion: In addition to patient non-compliance and multiple providers managing thyroid hormone, physicians reported that patient requests for tests and treatments is a common barrier to managing thyroid hormone therapy. Endocrinologists, high case volume physicians and those with fewer years in practice were more likely to report patient requests as a barrier. Along with addressing over- and undertreatment and patient dissatisfaction with thyroid hormone, key to improving care is also understanding physician reported barriers to managing thyroid hormone replacement. Furthermore, more research is needed to understand factors associated with physician perception that patient requests are a barrier.