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New Clinical Guidelines for Management of Hypothyroidism in Adults

Updated clinical practice guidelines jointly developed by the American Association of Clinical Endocrinologists (AACE) and the American Thyroid Association (ATA) regarding optimal evaluation, treatment and follow-up of patients with hypothyroidism have been released and are now available….

The guidelines also are scheduled to be published in the November-December 2012 issue of Endocrine Practice, the peer-reviewed journal of AACE.

Hypothyroidism occurs when the thyroid gland produces too little thyroid hormone, slowing down the body’s metabolic processes and producing symptoms ranging from fatigue, lethargy and depression to dry skin and hair, muscle cramps and infertility. The NIH’s National Endocrine and Metabolic Diseases Information Service estimates approximately 4.6 percent of the U.S. population age 12 and older has hypothyroidism.

Fifty-two evidence-based clinical recommendations were developed by the joint task force’s expert clinicians to aid in the diagnosis and care of hypothyroidism patients. Among the key highlights and recommendations:

  • Although most physicians can diagnose and treat hypothyroidism, an endocrinologist should be consulted when children and infants, pregnant patients and women planning conception, those with heart disease, and those with other endocrine diseases such as adrenal and pituitary disorders, are affected.
  • A serum TSH (thyroid-stimulating hormone) is the single best screening test for hypothyroidism. It is not sufficient for assessing hospitalized patients or when central hypothyroidism is present or suspected (central hypothyroidism is due to a decrease in the secretion of TSH from the pituitary gland).
  • Hypothyroidism should be treated with Levothyroxine (T4).
  • No clinical data exists to support the effectiveness of over-the-counter products marketed for "thyroid support" or to promote "thyroid health."
  • Levothyroxine (T4) and Levotriiodothyronine (T3) combinations, including desiccated thyroid, should not be used during pregnancy or in those who are planning pregnancy.
  • Mild TSH elevations in the elderly may be a normal manifestation of aging and not necessarily indicate hypothyroidism.

Lead author Jeffrey R. Garber, M.D., chair of the AACE and ATA taskforce on hypothyroidism in adults, president of the American College of Endocrinology (ACE) and Harvard Vanguard Medical Associates’ endocrine division chief stated that, " ‘The Clinical Practice Guideline for Management of Hypothyroidism’ is based on a comprehensive review and assessment by experts of what has been published about hypothyroidism." "We trust that by providing evidenced-based guidelines for patients with hypothyroidism the quality of care for this common, important and readily treatable condition will improve."

http://aace.metapress.com/content/B67V7MK73G3233N2