September 14, 2012 — Fifty-two evidence-based recommendations for the optimal evaluation, treatment, and follow-up of patients with hypothyroidism have been released in an effort to help clinicians provide patients with optimal care.
Jointly developed by the American Association of Clinical Endocrinologists and the American Thyroid Association, the recommendations were published online simultaneously in Endocrine Practice and Thyroid .
Of particular note for primary care clinicians:
Clinicians are advised to consult with an endocrinologist when treating hypothyroidism in infants and pediatric patients, women who are or plan to become pregnant, patients with heart disease, and those with other endocrine diseases such as adrenal or pituitary disorders, as well as patients for whom it is "difficult to render and maintain a euthyroid state"; those with a goiter, nodule or structural changes to the thyroid; or those who have an "unusual constellation of thyroid function test results."
Although a serum thyrotrophin hormone (TSH) test is the single best screening test for hypothyroidism, clinicians should be aware that it is insufficient for assessing hospitalized patients or when central hypothyroidism is either present or suspected.
The standard treatment for hypothyroidism is individually tailored replacement levothyroxine; there are no data to support the clinical efficacy of over-the-counter products marketed for "thyroid support" or "to promote thyroid health."
Levothyroxine and levotriiodothyronine combinations, including desiccated thyroid, should not be used in women who are pregnant or trying to conceive.
Mild TSH elevations in the elderly may be a normal manifestation of aging and do not necessarily indicate hypothyroidism.
"The guidelines address a wide-ranging number of issues that clinicians encounter in treating a disorder that affects millions of men worldwide and an even far greater number of women," Charles H. Emerson, MD, said in a news release Dr. Emerson is editor-in-chief of Thyroid and professor emeritus of medicine at the University of Massachusetts Medical School in Worcester. "They deal firmly with the problem of inappropriate thyroid hormone administration, both as it concerns individuals who should not be taking thyroid hormone, and patients with hypothyroidism who are given or self-administer suboptimal doses or dangerous formulations for their condition," he added.
One author has received speaker and program development honoraria from Abbott Nutrition. The remaining authors have disclosed no relevant financial relationships.
Thyroid. Published online September 11, 2012. Full text
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Cite this: Hypothyroidism Evaluation and Treatment Guidelines Released - Medscape - Sep 14, 2012.