INTRODUCTION: Hypothyroidism is a prevalent endocrine disorder predominantly managed in primary care. Improper treatment can lead to significant clinical and public health consequences. Despite the availability of clear clinical guidelines, over- and undertreatment frequently occur. The aim was to explore and map indications of over- and undertreatment of hypothyroidism in a primary care setting. METHODS: We conducted a scoping review guided by Arksey and O'Malley. The search was conducted in PubMed, Embase, CINAHL, Scopus, and the Cochrane Library. We included peer-reviewed studies exploring over- and undertreatment of hypothyroidism in primary care and included both registry/audit and survey studies. Data were extracted across four structured stages, capturing study characteristics and treatment-related outcomes. Data on indications were compared across studies to identify recurring patterns. RESULTS: Nineteen studies were included. The findings show that the majority of studies with larger study populations report a moderate prevalence of over- and undertreatment. Overtreatment was associated with early initiation of therapy, absence of confirmatory testing, and suppressed TSH levels during follow-up. Undertreatment was linked to incomplete diagnostic evaluation, delayed treatment initiation, and inadequate follow-up. Survey studies reported similar patterns of inappropriate management but higher adherence to clinical guidelines. CONCLUSION: This scoping review found consistent evidence of both over- and undertreatment of hypothyroidism in primary care. A discrepancy between clinicians' reported intentions and observed practice suggests the need to attend to behavioural and organisational factors, and to provide greater support for individualised decision-making to improve care.
Sloth et al. (Sat,) studied this question.