Hypothyroidism guidelines recommend case-finding testing, treatments, when to consult an endocrinologist

New guidelines on managing hypothyroidism in adults have been issued by the American Association of Clinical Endocrinologists and the American Thyroid Association.

Published in Thyroid, the guidelines comprise 52 evidence-based recommendations. Among them are the following:

• Serum thyroid-stimulating hormone (TSH) is the single best screening test for primary thyroid dysfunction in outpatient care, but it is not sufficient in hospitalized patients or when central hypothyroidism is present or suspected.
• The standard treatment for hypothyroidism is replacement with L-thyroxine (T4).
• The decision to treat subclinical hypothyroidism, when the serum TSH is less than 10 mIU/L, should be tailored to the individual patient.

The authors wrote that while there is no consensus about population screening for hypothyroidism, evidence supports case-finding for hypothyroidism in patients with autoimmune diseases such as type 1 diabetes, pernicious anemia, a first-degree relative with autoimmune thyroid disease, a history of neck radiation to the thyroid gland, a prior history of thyroid surgery or dysfunction, an abnormal thyroid examination, psychiatric disorders, and patients taking amiodarone or lithium.

Most physicians can diagnose and treat hypothyroidism, the experts said, but an endocrinologist should be consulted for:

• children and infants,
• patients who cannot maintain a euthyroid state,
• women who are pregnant or planning to become pregnant,
• patients with cardiac disease,
• patients with a goiter, nodule, or other structural changes in the thyroid gland,
• patients with other endocrine disease such as adrenal and pituitary disorders,
• patients with unusual thyroid function test results, or
• patients whose disorders have unusual causes.