Hypothyroidism is an endocrine disease in which the circulating levels of thyroid hormone are insufficient to maintain normal metabolic function. This causes fatigue, fluid retention, difficulty concentrating, bradycardia, and hyponatremia. If left untreated, hypothyroidism can be fatal, but this is very rare. However, hypothyroidism as a disease is quite common, affecting 5-10% of the population. The primary treatment of hypothyroidism--levothyroxine--is one of the most frequently prescribed medications in the US. Because hypothyroidism is so common and usually straightforward to diagnosis, many patients receive treatment in the primary care setting. However, there are challenges facing primary care clinicians in hypothyroidism management. First, most patients who are diagnosed with hypothyroidism remain on treatment for the rest of their lives and dose adjustments are required to maintain therapeutic levels of thyroid hormone. This has resulted in high levels of overtreatment and undertreatment (as many as 40% in some studies). Second, there is minimal guidance on how to monitor patients over time, leading clinicians to rely on clinical experience which can result in extended monitoring gaps. Third, some patients continue to have symptoms of hypothyroidism despite having therapeutic levels of thyroid hormone. This can present a diagnostic dilemma for clinicians. In this study, we will ask primary care clinicians about their understanding of hypothyroidism management and where they go for clinical support when needed (if at all). This knowledge will contribute to the development of a clinical decision support system which will assist primary care clinicians in managing hypothyroidism.

1. Evaluate the knowledge and perceptions of primary care clinicians in the basic framework of hypothyroidism management.

2. Identify the sources of information that clinicians use to help guide decision-making in hypothyroidism management.

3. Characterize the challenges in hypothyroidism management that primary care clinicians identify in their own practice.

This will be a cross-sectional needs assessment of hypothyroidism management for primary care clinicians. The data will be collected through a survey distributed online. Primary care clinicians at the attending level will be eligible to complete the survey. The survey will be distributed within the University of Chicago primary care group, and, if possible, at external practices as well. Learned skills will include efficient survey design to maximize effectiveness and minimize required time by participants. Basic statistical techniques (descriptive statistics, t and chi square tests) will be required to analyze the data.

REDCap, excel

ENDO, American Thyroid Association, SGIM