Matthew D Ettleson, Antonio C Bianco, Wen Wan, Neda Laiteerapong
The Journal of Clinical Endocrinology & Metabolism, Volume 107, Issue 8, August 2022, Pages e3411–e3419
https://doi.org/10.1210/clinem/dgac215
Many patients with hypothyroidism receive suboptimal treatment that may affect hospital outcomes.
This work aimed to identify differences in hospital outcomes between patients with and without hypothyroidism.
A retrospective cohort study, using the propensity score-based fine stratification method to balance covariates, was conducted using a large, US-based, commercial claims database from January 1, 2008 to December 31, 2015. Participants included patients aged 64 years and younger who had a thyrotropin (TSH) level collected before a hospital admission. Covariates included age, sex, US region, type of admission, year of admission, and comorbidities. Exposure included clinical hypothyroidism, which was divided into 4 subgroups based on prehospitalization TSH level: low (TSH < 0.40 mIU/L), normal (TSH 0.40–4.50 mIU/L), intermediate (TSH 4.51–10.00 mIU/L), and high (TSH > 10.00 mIU/L).
length of stay (LOS), in-hospital mortality, and readmission outcomes.
A total of 43 478 patients were included in the final study population, of whom 8873 had a diagnosis of hypothyroidism. Those with a high prehospitalization TSH level had an LOS that was 1.2 days longer (95% CI, 1.1–1.3; P = .003), a 49% higher risk of 30-day readmission (relative risk [RR] 1.49; 95% CI, 1.20–1.85; P < .001), and a 43% higher rate of 90-day readmission (RR 1.43; 95% CI, 1.21–1.67; P < .001) compared to balanced controls. Patients with normal TSH levels exhibited decreased risk of in-hospital mortality (RR 0.46; 95% CI, 0.27–0.79; P = .004) and 90-day readmission (RR 0.92; 95% CI, 0.85–0.99; P = .02).
The results suggest suboptimal treatment of hypothyroidism is associated with worse hospital outcomes, including longer LOS and higher rate of readmission.
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