Treatment Guidelines for Patients With Hyperthyroidism and Hypothyroidism

Сингер, Петер; Cooper, David S.; Levy, Elliot G.; Ladenson, Paul W.; Braverman, Lewis E.; Daniels, Gilbert H.; Greenspan, Francis S.; McDougall, I. Ross; Nikolai, Thomas F.

doi:10.1001/jama.1995.03520340064038

Cited by 327 publications

(129 citation statements)

References 9 publications

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“…Thyroid dysfunction is common in adults [1][2][3] and can be diagnosed accurately by laboratory tests [4,5]. Commonly done tests to diagnose thyroid disorders include estimation of thyroid stimulating hormone (TSH) along with thyroid hormones, tri iodothyronine (T3) & tetra iodothyronine (T4) either in total or free form.…”

Section: Introductionmentioning

confidence: 99%

“…The guidelines of American thyroid association and American Association of Clinical Endocrinologists recommend serum TSH measurement as the single most reliable test to diagnose all common forms of hypothyroidism and hyperthyroidism particularly in the ambulatory setting [6,7]. Thyroid stimulating hormone confirms or excludes the diagnosis in all patients with primary hypothyroidism, an elevated concentration being present in both overt and mild hypothyroidism [4]. Patients with hyperthyroidism have serum TSH concentration less than 0.1 mIU/ml and usually less than 0.05 mIU/ml.…”

Section: Introductionmentioning

confidence: 99%

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Are we using Thyroid Function Tests Appropriately?

et al. 2011

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Thyroid function tests are very important for the diagnosis and monitoring of patients with thyroid dysfunction. The guidelines recommend serum thyroid stimulating hormone (TSH) as the single most reliable test to diagnose all common forms of hypothyroidism and hyperthyroidism. The aim of this study was to analyze the ordering pattern for thyroid function tests by physicians and the analysis of results based on the clinical history. The mean age of the patients was 32.5 ± 6.5 years. Majority of samples (87.7% of total) were received from the departments of Medicine and Gynae. Thyroid profiles (47.5%) were ordered more frequently as compared to TSH only (46%). There was no significant difference in the percentage of normal reports for both types of tests. 77.8% of TFT and 76.6% of TSH samples had results within the reference range. The percentage of abnormal results was 13.7% in the patients who were screened for thyroid disorders. There is a need to redefine the case definition for thyroid dysfunction and order the appropriate test in a rational and cost effective manner.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Are we using Thyroid Function Tests Appropriately?

et al. 2011

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“…Nenhuma delas é considerada ideal, visto que não atuam diretamente na etiologia / patogê-nese da doença (21). O tratamento de primeira escolha tem variado nos diferentes países (Tabela 1).…”

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Tratamento do hipertireoidismo da Doença de Graves

Andrade

Gross

Maia

2001

Arq Bras Endocrinol Metab

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A Doença de Graves constitui a forma mais comum de hipertireoidismo e três abordagens terapêuticas são atualmente utilizadas: drogas antitireoidianas (DAT), cirurgia e iodo radioativo (131I). As DAT continuam como tratamento de primeira escolha em pacientes com doença leve, bócios pequenos, crianças e adolescentes, e em situações especiais como na gravidez. Por outro lado, o 131I tem sido cada vez mais utilizado, porque é considerado um tratamento seguro, definitivo e de fácil aplicação. O risco de exacerbação do hipertireoidismo após administração do 131I, os fatores prognós-ticos de falência e o cálculo da dose administrada têm sido alguns dos aspectos discutidos na literatura recentemente, e são particulamente comentados nesta revisão. O tratamento cirúrgico constitui quase um tratamento de exceção, com indicação para os casos em que as terapias anteriores não possam ser utilizadas. ABSTRACT ABSTRACTGraves' disease is the most frequent cause of hyperthyroidism and current treatments consist of antithyroid drugs (ATD), radioiodine (131I) and surgery. ATD are the first choice of treatment in patients with mild disease, small goiters, children, adolescents and in special situations as pregnancy. On the other hand, 131I is increasingly being used as definitive therapy, because it long has proven to be a safe, cheap and effective treatment. The risk of exacerbation of hyperthyroidism after 131I administration, factors that may predict the response to radioiodine and the dose to be administrated have been discussed in the literature and we comment the controversies in this review. Surgery is rarely employed, and it is indicated only in cases where ATD have not been effective, radioiodine is contraindicated or not acceptable to the patients. A DOENÇA DE GRAVES CONSTITUI A FORMA mais comum de hipertireoidismo (60%-80%), afetando principalmente as mulheres (5-10:1) entre 40-60 anos (1). Na Inglaterra apresenta uma prevalência de 2% em mulheres e 0,2% em homens, enquanto nos EUA estima-se que acometa 0,4% da população (2). A maioria dos estudos relata taxas de incidência de 0,5/1000 indivíduos/ano e o risco calculado de mulheres e homens desenvolverem hipertireoidismo em alguma fase de suas vidas é de 5% e 1% respectivamente (3).O hipertireoidismo da Doença de Graves é caracterizado imunologicamente por infiltração linfocitária da glândula tireóide e por ativação

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“…Many investigators [8][9][10][11][12] and several organizations, such as the American Thyroid Association, the American College of Physicians, the American Academy of Family Physicians, and the American Association of Clinical Endocrinologists recommend testing persons who have a greater likelihood of being hypothyroid. [13][14][15][16] The recommendations of the American College of Physicians, for example, include testing women over age 50 "who have general symptoms that could be caused by thyroid disease." 14 The U.S. Preventive Services Task Force does not recommend for or against screening in high-risk patients, such as older women.…”

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confidence: 99%

Do traditional symptoms of hypothyroidism correlate with biochemical disease?

1997

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OBJECTIVE:Hypothyroidism often remains undetected because of the difficulty associating symptoms with disease. To determine the relation between symptoms and biochemical disease, we assessed symptoms and serum thyroid function tests, concurrently, for patients with and without hypothyroidism. DESIGN:Cross-sectional study. SETTING/PATIENTS: CONCLUSIONS:In this sample, the number of hypothyroid symptoms reported was directly related to the level of TSH. The association was stronger when more symptoms were reported. Symptoms that had changed in the past year were more powerful than symptoms reported present at the time of testing. This suggests that traditional symptoms are valuable when deciding which patients to test for hypothyroidism.

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Treatment Guidelines for Patients With Hyperthyroidism and Hypothyroidism

Cited by 327 publications

References 9 publications

Are we using Thyroid Function Tests Appropriately?

Are we using Thyroid Function Tests Appropriately?

Tratamento do hipertireoidismo da Doença de Graves

Do traditional symptoms of hypothyroidism correlate with biochemical disease?

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