Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists

Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists

The American Thyroid Association and American Association of Clinical Endocrinologists Taskforce on Hyperthyroidism and Other Causes of Thyrotoxicosis

Rebecca S. Bahn (Chair),1,* Henry B. Burch,2 David S. Cooper,3 Jeffrey R. Garber,4 M. Carol Greenlee,5 Irwin Klein,6 Peter Laurberg,7 I. Ross McDougall,8 Victor M. Montori,1 Scott A. Rivkees,9 Douglas S. Ross,10 Julie Ann Sosa,11 and Marius N. Stan1

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 article describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspeciality physicians and others providing care for patients with this condition.

Methods: The development of these guidelines was commissioned by the American Thyroid Association in association with the American Association of Clinical Endocrinologists. The American Thyroid Association and American Association of Clinical Endocrinologists assembled a task force of expert clinicians who authored this report. The task force 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 develop the text and a series of specific recommendations. The strength of the recommendations and the quality of evidence supporting each was 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' ophthalmopathy; and management of other miscellaneous causes of thyrotoxicosis.

Conclusions: One hundred 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.

By mutual agreement among the authors and editors of their respective journals, this work is being published jointly in Thyroid and Endocrine Practice.

*Authors are listed in alphabetical order.
1Division of Endocrinology, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota.
2Endocrinology and Metabolism Division, Walter Reed Army Medical Center, Washington, District of Columbia.
3Division of Endocrinology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
4Endocrine Division, Harvard Vanguard Medical Associates, Boston, Massachusetts.
5Western Slope Endocrinology, Grand Junction, Colorado.
6The Thyroid Unit, North Shore University Hospital, Manhassett, New York.
7Department of Endocrinology, Aarhus University Hospital, Aalborg, Denmark.
8Division of Nuclear Medicine, Department of Radiology and Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, California.
9Department of Pediatrics, Yale Pediatric Thyroid Center, New Haven, Connecticut.
10Massachusetts General Hospital, Boston, Massachusetts.
11Divisions of Endocrine Surgery and Surgical Oncology, Yale University School of Medicine, New Haven, Connecticut.

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