2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis
2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis
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DOI：
10.1089/thy.2016.0229
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发表时间：
2016-10-01
期刊：
影响因子：
6.6
通讯作者：
Walter, Martin A.
中科院分区：
文献类型：
--
作者：
Ross, Douglas S.;Burch, Henry B.;Walter, Martin A.
背景：甲状腺毒症有多种病因、表现和潜在的治疗方法。适当的治疗需要准确的诊断，并受到共存的医疗条件和患者偏好的影响。本文档描述了甲状腺毒症管理的循证临床指南，对全科医生和亚专科医生以及其他提供这种疾病患者护理的医生有用。方法：美国甲状腺协会（ATA）于2011年发布了甲状腺毒症治疗指南。自那时以来，已经发表了大量新的文献，ATA认为有必要更新循证指南。该协会组建了一个由临床专家组成的工作组，撰写了这份报告。他们使用系统的PubMed检索和其他已发表的材料来检查相关文献。在更新2011年的文本和建议时，采用了一种纳入专家小组知识和经验的循证医学方法。根据建议、评估、发展和评估小组推荐的分级方法，对建议的强度和支持这些建议的证据质量进行了评级。结果：讨论的临床主题包括甲状腺毒症的初步评估和管理；使用放射性碘、抗甲状腺药物或手术治疗Graves甲亢；放射性碘或手术治疗中毒性多结节性甲状腺肿或中毒性腺瘤儿童、青少年或孕妇的Graves病；亚临床甲状腺机能亢进;Graves眼病患者甲状腺功能亢进；以及其他各种原因的甲状腺毒症的处理。自2011年指南发布以来，提出了甲状腺毒症病因评估、抗甲状腺药物治疗Graves甲亢、妊娠甲亢患者管理以及甲状腺手术患者准备的新范式。关于甲状腺毒症的不常见原因的部分已经扩大。结论：制定了124项基于证据的建议，以帮助甲状腺毒症患者的护理，并分享工作组认为当前、合理和最佳的医疗实践。
Background: Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This document describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspecialty physicians and others providing care for patients with this condition. Methods: The American Thyroid Association (ATA) previously cosponsored guidelines for the management of thyrotoxicosis that were published in 2011. Considerable new literature has been published since then, and the ATA felt updated evidence-based guidelines were needed. The association assembled a task force of expert clinicians who authored this report. They examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to update the 2011 text and recommendations. The strength of the recommendations and the quality of evidence supporting them were rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. Results: Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' orbitopathy; and management of other miscellaneous causes of thyrotoxicosis. New paradigms since publication of the 2011 guidelines are presented for the evaluation of the etiology of thyrotoxicosis, the management of Graves' hyperthyroidism with antithyroid drugs, the management of pregnant hyperthyroid patients, and the preparation of patients for thyroid surgery. The sections on less common causes of thyrotoxicosis have been expanded. Conclusions: One hundred twenty-four evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.