Jeffrey R. Garber,1,2,* Rhoda H. Cobin,3 Hossein Gharib,4 James V. Hennessey,2 Irwin Klein,5 Jeffrey I. Mechanick,6 Rachel Pessah-Pollack,6,7 Peter A. Singer,8 and Kenneth A. Woeber9
for the American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults
Background: Hypothyroidism has multiple etiologies and manifestations. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions. This paper describes evidence-based clinical guidelines for the clinical management of hypothyroidism in ambulatory patients.
Methods: The development of these guidelines was commissioned by the American Association of Clinical Endocrinologists (AACE) in association with American Thyroid Association (ATA). AACE and the ATA assembled a task force of expert clinicians who authored this article. The authors examined relevant literature and took an evidence-based medicine approach that incorporated their knowledge and experience to develop a series of specific recommendations and the rationale for these recommendations. The strength of the recommendations and the quality of evidence supporting each was rated according to the approach outlined in the American Association of Clinical Endocrinologists Protocol for Standardized Production of Clinical Guidelines—2010 update.
Results: Topics addressed include the etiology, epidemiology, clinical and laboratory evaluation, management, and consequences of hypothyroidism. Screening, treatment of subclinical hypothyroidism, pregnancy, and areas for future research are also covered.
Conclusions: Fifty-two evidence-based recommendations and subrecommendations were developed to aid in the care of patients with hypothyroidism and to share what the authors believe is current, rational, and optimal medical practice for the diagnosis and care of hypothyroidism. A serum thyrotropin is the single best screening test for primary thyroid dysfunction for the vast majority of outpatient clinical situations. The standard treatment is replacement with L-thyroxine. The decision to treat subclinical hypothyroidism when the serum thyrotropin is less than 10 mIU/L should be tailored to the individual patient.
By mutual agreement among the authors and the editors of their respective journals, this work is being published jointly in Thyroid and Endocrine Practice.
*Jeffrey R. Garber, M.D., is Chair of the American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults. All authors after the first author are listed in alphabetical order.
1Endocrine Division, Harvard Vanguard Medical Associates, Boston, Massachusetts.
2Division of Endocrinology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
3New Jersey Endocrine and Diabetes Associates, Ridgewood, New Jersey.
4Division of Endocrinology, Mayo Clinic, Rochester, Minnesota.
5The Thyroid Unit, North Shore University Hospital, Manhassett, New York.
6Division of Endocrinology, Mount Sinai Hospital, New York, New York.
7Division of Endocrinology, ProHealth Care Associates, Lake Success, New York.
8Keck School of Medicine, University of Southern California, Los Angeles, California.
9UCSF Medical Center at Mount Zion, San Francisco, California.
Supplementary Data (PDF File, 69 KB)
Address correspondence to:
Jeffrey R. Garber, M.D.
Endocrinology Division Harvard Vanguard Medical Associates
133 Brookline Avenue
Boston, MA 02215