Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association
Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association
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DOI：
10.1089/thy.2012.0205
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发表时间：
2012-12-01
期刊：
影响因子：
6.6
通讯作者：
Woeber, Kenneth A.
中科院分区：
文献类型：
--
作者：
Garber, Jeffrey R.;Cobin, Rhoda H.;Woeber, Kenneth A.
背景：甲状腺功能减退症有多种病因和表现。适当的治疗需要准确的诊断，并受共存的医疗条件的影响。本文介绍了循证临床指南的临床管理甲状腺功能减退症的门诊病人。方法：这些指南是由美国临床内分泌学家协会（AACE）联合美国甲状腺协会（ATA）委托制定的。AACE和ATA组建了一个由专家临床医生组成的工作组，撰写了这篇文章。作者查阅了相关文献，并采用循证医学方法，结合他们的知识和经验，提出了一系列具体建议和这些建议的基本原理。建议的强度和支持每项建议的证据质量是根据美国临床内分泌学家协会临床指南标准化生产协议-2010年更新中概述的方法进行评级的。结果：讨论的主题包括病因学、流行病学、临床和实验室评估、管理和甲状腺功能减退的后果。筛选，治疗亚临床甲状腺功能减退症，怀孕，并为未来的研究领域也涵盖。结论：制定了52条循证建议和亚建议，以帮助甲状腺功能减退患者的护理，并分享作者认为当前、合理和最佳的甲状腺功能减退诊断和护理医疗实践。血清促甲状腺素是绝大多数门诊临床情况下原发性甲状腺功能障碍的单一最佳筛查试验。标准治疗是用l -甲状腺素替代。当血清促甲状腺素低于10 mIU/L时，治疗亚临床甲状腺功能减退的决定应根据患者的具体情况而定。
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.