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Management Of Thyrotoxicosis Among General Practitioners In Trinidad Compared With 2016 American Thyroid Association Guidelines For Hyperthyroidism.

Teelucksingh S, Motilal MS, Bailey H, Sookhai SP, Sooknanan J, Soongoon-Padarath SA, Sookram A, Sookram V, Spann JK, Stewart DJ, Sudama S, Surujbally AV, Kanhai CD.

Endocr Pract.

2019

Mar

HyperthyroidismGeneral PractitionerSurvey

Abstract OBJECTIVES A previous Trinidadian survey highlighted the investigative and therapeutic approaches selected by general practitioners (GPs) in managing thyrotoxicosis. The main objective of this study was to compare practice with existing guidelines. METHODS In this cross-sectional study a pretested de novo questionnaire was self-administered to GPs throughout Trinidad. The survey evaluated GPs' choices in management of thyrotoxicosis cases and compared their responses to the 2016 American Thyroid Association guidelines as well as with those previously reported locally. RESULTS A total of 159 completed questionnaires were analyzed (59% response rate) Thyroid stimulating hormone was the preferred (94%) biochemical test to confirm thyrotoxicosis etiology. A combination of ultrasound and thyroid scintigraphy, thyroid ultrasound alone, scintigraphy only were the testing options selected by 41%, 38% and 12% respectively. Generally medical therapy with antithyroid drugs was the preferred treatment option with 86% of respondents selecting this option for the index case of newly diagnosed female Graves' disease. The greatest proportion of respondents that selected radioactive iodine (RAI) was 35% for both the index case as well as the male equivalent. Surgery was the most popular option at 25% for the patient with a toxic multinodular goiter. Having access to RAI and scintigraphy was reported by 32% and 28% respectively. CONCLUSION GPs appear to be constrained to making rational choices based upon availability rather than what the guidelines recommend. In the absence of formal continuing medical education on thyrotoxicosis for GPs, dissemination of guidelines at the primary care level may reduce this gap.

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