Another paper TUK posters may find interesting

[diogenes]

This open access paper describes the desirability of patient-centered diagnosis and treatment.

Women’s Health Reports Volume 2.1, 2021

DOI: 10.1089/whr.2021.0010 Accepted April 27, 2021

Open Access

Improving the Quality of Life of Patients

with an Underactive Thyroid Through mHealth:

A Patient-Centered Approach

Vedrana Ho ̈gqvist Tabor,1,*,i Mikael Ho ̈gqvist Tabor,1 Sarai Keestra,2,3 Jean-Etienne Parrot,1 and Alexandra Alvergne2,4

[shaws Administrator]

Thanks for posting diogenes and it does sound interesting i.e.

"of patient-centered diagnosis and treatment".

[vocalEK]

Is there a link to the article?

[TSH110 in reply to vocalEK]

Searched like crazy but got zilch

[diogenes Remembering in reply to TSH110]

I put into Google:

Improving the Quality of Life of Patients with an Underactive Thyroid Through mHealth: A Patient-Centered Approach

and the article in Thyroid came up OK.

[TSH110 in reply to diogenes]

Mmm odd it said there were no matches on google and Safari let me try again. Thanks

Tried again got nothing… well I lie, a 2019 article of yours comes up and a few others but not that one…how strange

[TSH110]

I tried searching for it but drew a complete blank. Do you have a link for it diogenes?

[diogenes Remembering in reply to TSH110]

I've identified a paper which may have been the origin of the article in question. It is:

Returning to a Patient-Centered Approach in the Management of Hypothyroidism

September 2020

The Annals of Family Medicine 18(5):388-389

DOI: 10.1370/afm.2602

It's behind a paywall but I've asked for the documnt to be sent to me

[humanbean in reply to diogenes]

I've just got a link for the article you refer to above :

annfammed.org/content/annal...

I've read it all and it is mostly quite interesting, but I'm afraid my hackles were raised by the very first paragraph - my bold :

Shared decision making is an important aspect of high-quality health care and incorporates understanding patients’ beliefs around how medication works, the potential side effects, and expected benefits. Gaining this understanding helps to guide the decision of which medications most closely align with patients’ beliefs and expectations. This may be especially important for improving adherence to chronic medications, and in particular, for thyroid medication where 40 to 50% of patients do not take their medication as prescribed.1

I simply don't believe that 40% to 50% of patients don't take their medication as prescribed, at least in the UK, although I accept that the people whose posts I read on this forum are probably not typical of thyroid patients everywhere.

I would be prepared to believe that patients are given no instructions on how to take their prescribed Levo, and that many of them are wrongly dosed. And how many doctors might add another prescription a few months down the line and it screws up the thyroid? Probably quite a few, I suspect.

The reference [1] given was to this (full) paper :

Title : Adherence to thyroid hormone replacement therapy: a retrospective, claims database analysis

Link : tandfonline.com/doi/full/10...

I haven't read the whole reference, but I spotted a substantial source of bias in the abstract.

In the Methods section :

Patients were excluded if they were younger than age 18, were diagnosed with thyroid cancer, received a prescription for liothyronine, or did not have continuous insurance coverage over the study period.

Surely, patients in the USA with insurance are not comparable to patients without insurance?

And I suspect the non-adherent in the USA might be trying to save money on their pills, and that must be true in the USA for pills of all kinds for any chronic disease.

I found another paper by Hepp and others where they were looking at adherence and costs :

Title : The association between adherence to levothyroxine and economic and clinical outcomes in patients with hypothyroidism in the US

tandfonline.com/doi/full/10...

I found this comment in the paper rather funny in a sick kind of way :

Patients who were adherent used significantly fewer resources and had significantly lower all-cause ($14,136 vs. $14,926; p < .0001) and hypothyroidism-related ($1672 vs. $1709; p < .0001) total costs, although the costs of drugs were higher in the adherent group. Furthermore, adherent patients, compared to nonadherent patients, were significantly less likely to be diagnosed with comorbid Addison’s disease, bipolar disorder, chronic kidney disease, depression, migraine, obesity, type 1 diabetes or type 2 diabetes during the follow-up period.

Perhaps the people with any of the comorbid diseases mentioned had severe brain fog and memory problems. And in the US they definitely would have been much poorer than people with "just" hypothyroidism, increasing the chances they would be less adherent because they were trying to save money.