# On the way to deprescribing levothyroxine in subclinical hypothyroidism in general practice – the patients’ perspective of enablers and barriers

## TL;DR

Patients with subclinical hypothyroidism are open to stopping levothyroxine if guided by their doctor, but need clear information and support.

## Contribution

Identifies patient perspectives on enablers and barriers to deprescribing levothyroxine in subclinical hypothyroidism in primary care.

## Key findings

- Patients desire clear medical information and gradual deprescribing under GP supervision.
- Deprescribing is seen as beneficial for quality of life and reducing side effects.
- Patients express confidence in their general practitioner's guidance for deprescribing.

## Abstract

Recent studies indicate that the synthetic thyroid hormone levothyroxine (LTX) in many cases has no beneficial effects on patients with subclinical hypothyroidism. Still, prescriptions are increasing worldwide. If there is no clear indication for treatment, patients treated with LTX should be offered a deprescribing trial according to current guidelines. However, there is currently no protocol for deprescribing LTX in primary care.

We aimed to explore patients’ enablers and barriers towards deprescribing levothyroxine in primary care to inform the further participatory development of a deprescribing strategy.

Based on the COREQ checklist, focus group discussions were conducted with patients and general practitioners as well as patients only in 2024. Participants ranked the five most crucial enablers and barriers. Transcripts and prioritised elements were examined using the qualitative content analysis method according to Kuckartz.

Patients frequently felt misinformed about their condition and the prescription of LTX. A change in their medications raised doubts and uncertainties. However, the potential advantages and opportunities of deprescribing were compelling: a (re)gain of quality of life, a decrease in probable drug side effects, savings of time and cost. Mostly, patients welcomed a gradual and managed deprescribing under their general practitioner’s supervision.

Patients wished for medical information to reduce their doubts concerning deprescribing and expressed confidence in their general practitioner. Our findings indicate a fundamental commitment to deprescribing LTX. For an adherent process in general practitioners’ practices, a strategy that considers patients’ worries and concerns seems feasible.

Patients with subclinical hypothyroidism are open to having levothyroxine deprescribed if they are advised to do so by their general practitioner.

Targeted medical information, a stepwise approach, and close supervision by their general practitioner were identified as enablers.