Clinical practice guidelines for the management of hypothyroidism

Abstract

Introduction: Hypothyroidism has long been known for its effects on different organ systems, leading to hypometabolism. However, subclinical hypothyroidism, its most prevalent form, has been recently related to cardiovascular risk and also to maternal-fetal complications in pregnant women. Objectives: In these clinical practice guidelines, several aspects of this field have been discussed with the clear objectives of helping physicians treat patients with hypothyroidism, and of sharing some of our Latin American-based clinical experience. Materials and methods: The Latin American Thyroid Society commissioned a Task Force on Hypothyroidism to develop evidence-based clinical guidelines on hypothyroidism. A systematic review of the available literature, focused on the primary databases of MedLine/PubMed and Lilacs/SciELO was performed. Filters to assess methodological quality were applied to select the best quality studies. The strength of recommendation on a scale from A-D was based on the Oxford Centre for Evidence--based Medicine, Levels of Evidence 2009, allowing an unbiased opinion devoid of subjective viewpoints. The areas of interest for the studies comprised diagnosis, screening, treatment and a special section for hypothyroidism in pregnancy. Results: Several questions based on diagnosis, screening, treatment of hypothyroidism in adult population and specifically in pregnant women were posed. Twenty six recommendations were created based on the answers to these questions. Despite the fact that evidence in some areas of hypothyroidism, such as therapy, is lacking, out of 279 references, 73% were Grade A and B, 8% Grade C and 19% Grade D. Conclusions: These evidence-based clinical guidelines on hypothyroidism will provide unified criteria for management of hypothyroidism throughout Latin America. Although most of the studies referred to are from all over the world, the point of view of thyroidologists from Latin America is also given. Arq Bras Endocrinol Metab. 2013;57(4):265-99

Clinical and laboratory characteristics of patients with thyroid diseases with and without alanine aminotransferase levels above the upper tertile – Cross-sectional analytical study

“…with thyroid disease is 41-50 years (20,21), and the prevalence of hypothyroidism increases with increasing age of the population studied (25). Among our patients, 71% had Hashimoto's thyroiditis as the etiology of thyroid disease, which corroborates findings in the literature that this thyroiditis ranks as the leading cause of hypothyroidism (23,24). Liver disease is the primary cause of increased ALT levels.…”

“…With respect to the parameters of age (20,21) gender (22), and etiology of thyroid disease (23,24), the present study sample is consistent with previous studies of thyroid disease. The average age reported in indivi duals Figure 1.…”

Demographic and Clinical Factors Associated With the Appropriate Target Thyroid-Stimulating Hormone Values in Patients With Primary Hypothyroidism Treated With Levothyroxine

“…Its treatment aims to restore euthyroidism and to normalize metabolic alterations and risks associated with uncontrolled disease [6]. The treatments are based on thyroid-stimulating hormone (TSH) assessment, targeting the normal range in cases of benign disease, or TSH suppression for the treatment of differentiated thyroid carcinoma (DTC) [4,7].…”

Triagem de hipotireoidismo em crianças - Visão dos médicos da atenção primária à saúde de um município de médio porte

“…Como la obesidad infantil tiene una alta prevalencia, esto puede causar incremento en los costos de los servicios de salud y en las despensas generales en los servicios de atención especializada. Entre outras patologias autoimunes associadas à disfunção tireoidiana, estão a doença celíaca, o lúpus eritematoso sistêmico (LES) 21,28 e a artrite idiopática juvenil (AIJ). 29 Stagi et al 30 sugerem monitorização cuidadosa para essa possível associação durante o curso da AIJ.…”

“…Afirma, também, que a avaliação da função tireoidiana deve ser realizada em pacientes com sintomas clínicos de hipotireoidismo ou com história familiar de doença autoimune da tireoide, uma vez que há alta prevalência nesta última associação 21 . Não tem recomendações específicas de triagem para a população pediátrica.…”