Management of Primary Hypothyroidism: Statement by the British Thyroid Association Executive Committee

Statement by the British Thyroid Association Executive Committee

Onyebuchi Okosieme; Jackie Gilbert; Prakash Abraham; Kristien Boelaert; Colin Dayan; Mark Gurnell; Graham Leese; Christopher McCabe; Petros Perros; Vicki Smith; Graham Williams; Mark Vanderpump


Clin Endocrinol. 2016;84(6):799-808. 

In This Article


The current statement serves to update the previous 2008 and 2011 RCP joint position statements on the diagnosis and management of primary hypothyroidism. We have focused on patients with primary hypothyroidism and have not addressed in detail the care of subgroups such as pregnant women, patients treated for thyroid cancer or secondary hypothyroidism. Excellent guidelines for the management of these other conditions are available elsewhere. The statement is intended to provide concise guidance for primary care practitioners, hospital physicians, clinical biochemists and endocrinologists involved in caring for patients with hypothyroidism. A plain English summary of the guidelines will be made available for patients and interested members of the public on the websites of the BTA and BTF.

The statement has been developed following consultation within the BTA and with relevant stakeholder groups. All authors are members of the BTA executive committee with expertise in thyroid disease management and research. An initial face-to-face meeting was held in December 2014 by committee members, during which the scope and remit of the proposed position statement was decided. Following this, individual reviewers undertook a primary review that addressed key clinical questions relating to the diagnosis, indications, monitoring, therapeutic choice and treatment targets in the management of hypothyroidism. The primary reviewers examined the recent hypothyroidism guidelines of the ATA and ETA including original research informing these guidelines that were considered relevant to the remit of the current position statement. Furthermore, a systematic search of PubMed was undertaken, and additional references were sourced through references of individual articles. An initial draft was sent out to consultation by email to executive and senior members of the BTA who revised the original draft. Consensus on recommendations was reached through discussions. Wider consultations were then held with representatives of the SFE, ACB and RCP, as well as with the BTF, the patient support charity for thyroid disorders. The document was finalized following feedback from each of these bodies, and agreement from all authors was reached on the final statement. No external funding was received, either by the BTA or by individual members, for the development of this statement, and all conflict of interests are declared.

In addition to the statement, we have summarized the relevant recommendations from the ATA and ETA guidelines relating to the diagnosis and management of primary hypothyroidism. These recommendations are grouped into themes each addressing a specific clinical question. The strength of the recommendations and the quality of the evidence supporting these recommendations are included as judged by the authors of the original guidelines. Recommendations made in the BTA statement are also rated as strong (1) or weak recommendations (2) and the quality of evidence rated as high (+++), moderate (++0), low (+00) or insufficient (000) according to the GRADE system classification for clinical practice recommendations.[30,31]