Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association

TLDR

Hypothyroidism has multiple etiologies and manifestations, and its treatment requires accurate diagnosis and is influenced by coexisting medical conditions. This paper presents evidence‑based clinical guidelines for managing hypothyroidism in ambulatory patients, covering screening, treatment of subclinical disease, pregnancy, and future research, and offers 52 recommendations for optimal care. The guidelines were developed by an AACE‑ATA task force of expert clinicians who reviewed relevant literature using an evidence‑based medicine approach, rating recommendation strength and evidence quality per the AACE Protocol, and addressing etiology, epidemiology, evaluation, management, and consequences of hypothyroidism. Key findings include that serum thyrotropin is the best screening test for primary thyroid dysfunction, L‑thyroxine replacement is the standard treatment, and treatment of subclinical hypothyroidism with TSH < 10 mIU/L should be individualized.

Abstract

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.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.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.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.