Influence of educational level on test and treatment for incident hypothyroidism

Line Tang Møllehave*, Rikke Kart Jacobsen, Allan Linneberg, Tea Skaaby, Nils Knudsen, Torben Jørgensen, Line Lund Kårhus, Margit Kriegbaum, Mia Klinten Grand, Volkert Siersma, Bent Lind, Christen Lykkegaard Andersen, Birte Nygaard, Bjarke Borregaard Medici, Inge Bülow Pedersen, Gitte Ravn-Haren, Betina Heinsbaek Thuesen

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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OBJECTIVE: The incidence of hypothyroidism is not expected to differ by socioeconomic factors. However, the decision to test and initiate treatment may differ. We aimed to examine whether educational level influences the probability of thyroid stimulation hormone (TSH)-measurement and initiation of levothyroxine treatment.

DESIGN: Citizens in the greater Copenhagen Area during 2001-2015 were included. Individual-level data on educational level, diagnoses, GP-contact, TSH-measurement and medication were derived from administrative and healthcare registers. The relative risks (RR) between educational levels of annual TSH-measurement and treatment initiation following a TSH-measurement were analysed in Poisson regression models with generalized estimation equations.

RESULTS: A TSH-measurement was performed in 19% of 9,390,052 person years. The probability of TSH-measurement was higher with short (RR 1.16 [95% CI 1.15-1.16]) and medium (RR 1.11 [95% CI 1.06-1.12]) compared with long education. Treatment was initiated after 0.8% of 2,049,888 TSH-measurements. For TSH < 5 mIU/L, RR for treatment initiation ranged between 0.47 (95%CI 0.39-0.57) and 0.78 (95%CI 0.67-0.91) for short and medium compared with long education. For TSH 5-10 mIU/L, there was no statistically significant difference. For TSH > 10 mIU/L, RR was 1.07 (95% CI 1.02-1.12) for short and 1.08 (95% CI 1.03-1.13) for medium compared with long education.

CONCLUSION: The probability of TSH-measurement was higher with shorter education, and the probability of treatment initiation with TSH > 10 mIU/L was marginally higher with short-medium education compared with long education. However, the probability of treatment initiation with TSH < 5 mIU/L, that is treatment incongruous with guidelines, was substantially higher in persons with long education.

Original languageEnglish
JournalClinical Endocrinology
Issue number6
Pages (from-to)1025-1034
Number of pages10
Publication statusPublished - 2021


  • Hypothyroidism
  • Levothyroxine
  • Socioeconomic factors
  • Thyroid function tests


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