Endocrine Abstracts

Objectives: Some hypothyroid patients are critical of their care, although this appears to vary between countries. The quality of thyroid care delivered, and the perceived patient experience may be influenced by characteristics of specialists such as age, sex, experience, and workplace setting. Here, we aimed to explore geographical differences in thyroid specialist characteristics.

Methods: THESIS is a large European questionnaire survey of thyroid specialists treating patients with hypothyroidism. Participants were reached via the endocrine societies of 26 European countries plus Israel and Turkey. The questionnaire included questions about respondent demographic characteristics. Geographic regions were defined according to the UN Statistics Division definition (Eastern Europe, Western Europe, Northern Europe, Southern Europe, Western Asia). Data on gross national income per capita (GNIPC) in US dollars from the World Bank were used.

Results: A total of 16,733 invitations yielded 6,058 responses (93% endocrinologists). The median response rate was 43.5% and differed significantly between countries (6.8%-95.2%, P < 0.01). The mean age, the proportion of female respondents, and GNIPC were not associated with response rates. The proportion of females ranged between 36.6-93.9% (median 63.7%)). The lowest proportion of females was in Northern Europe (45.6%) and the highest in Eastern Europe (77.2%). The proportion of females differed between regions (moderate association, P < 0.001, Cramer’s v 0.21). GNIPC was inversely associated with the proportion of female respondents (P < 0.001, r2=0.42). An inverse correlation was noted between respondent age and proportion of females (Cochran-Armitage test for trend, P < 0.001, two-sided). The sample included 794 (16.2%) respondents working exclusively in private practice. The distribution of respondents in private practice differed between countries with a strong association (P < 0.001, Cramer’s v 0.40). Decreasing GNIPC correlated with an increasing proportion of respondents working privately (P < 0.011, r2=0.23). The proportion of respondents who reported treating over 100 hypothyroid patients/year was 62.1%. As GNIPC increased the percentage of respondents who treated more than 100 patients/year decreased (P < 0.01, r2=0.36).

Conclusion: Differences in characteristics of specialists who treat hypothyroid patients exist both at the country and the regional levels, with the greatest differences noted between Northern and Eastern Europe. The most significant determinant for these differences is GNIPC, although other factors, not addressed in this survey (organization of healthcare, culture) may also play a role. These differences may influence the management of hypothyroidism and patient satisfaction.