Development of a strategy for deprescribing levothyroxin (LTX) accepted by patients with subclinical hypothyroidism (SH) - what motivations and barriers do patients have?

Melanie Rennert, Anne-Kathrin Geyer, Stefan Hager, Sandy Scheibe, Annika Rettich, Karen Voigt, Jeannine Schübel, Tobias Deutsch, Markus Bleckwenn

Keywords: deprescribing, hypothyroidism, levothyroxin, qualitative research, participatory research, focus group interviews, patients, general practitioners

Background:

According to recent scientific findings, patients with latent hypothyroidism generally do not benefit from treatment with the thyroid hormone levothyroxine (LTX). Nevertheless, the number of prescriptions continues to rise. To reduce this partial overtherapy, there is currently no standardized procedure for deprescribing LTX.

Research questions:

What motivations and barriers are mentioned by patients with subclinical hypothyroidism with regard to discontinuing LTX?

Method:

As part of the qualitative research project DELTA-PIA (collaboration of Leipzig University and Dresden University of Technology), a deprescribing strategy is going to be developed using a participatory approach. Focus group discussions with two patient groups (n=13) and two mixed groups (n=10 patients, together with general practitioners and medical assistants) were conducted in March – May 2024 to explore motivations and barriers from different perspectives. Focus groups were recorded and transcribed. Furthermore prioritized aspects were analyzed using the method of qualitative content analysis (according to Kuckartz).

Results:

Ongoing analyzes indicate that patients often feel inadequately informed about their illness and medication. Potential changes in their medication create skepticism, uncertainty and concerns about possible symptomatic consequences. At the same time, patients also regard a gradual and controlled discontinuation positively, as the potential benefits and the resulting opportunities are convincing: a (re)gain of quality of life, the reduction of possible medication side effects or cost and time savings. A deprescribing strategy requires more in-depth medical information - in particular about possible risks of taking medication and potential benefit factors of discontinuing it.

Conclusions:

The results illustrate a general motivation in deprescribing LTX. A procedure is required that takes patient's motivations, as well as their worries and concerns, into account.

Points for discussion:

What materials could be used by general practitioners to provide information about advantages of deprescribing LTX for patients, f. e. the impacts, effects and process of deprescribing?

Which stakeholders could be relevant additionally to promote a deprescribing of LTX in context of motivations and concerns of patients with subclinical hypothyroidism?

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