Introduction

Introduction

THYROTOXICOSIS IS A CONDITION having multiple etiologies, manifestations, and potential therapies. The term ''thyrotoxicosis'' refers to a clinical state that results from inappropriately high thyroid hormone action in tissues generally due to inappropriately high tissue thyroid hormone levels. The term ''hyperthyroidism,'' as used in these guidelines, is a form of thyrotoxicosis due to inappropriately high synthesis and secretion of thyroid hormone(s) by the thyroid. Appropriate treatment of thyrotoxicosis requires an accurate diagnosis. For example, thyroidectomy is an appropriate treatment for some forms of thyrotoxicosis and not for others. Additionally, beta blockers may be used in almost all forms of thyrotoxicosis, whereas antithyroid drugs are useful in only some.

In the United States, the prevalence of hyperthyroidism is approximately 1.2% (0.5% overt and 0.7% subclinical); the most common causes include Graves' disease (GD), toxic multinodular goiter (TMNG), and toxic adenoma (TA) (1). Scientific advances relevant to this topic are reported in a wide range of literature, including subspeciality publications in endocrinology, pediatrics, nuclear medicine, and surgery, making it challenging for clinicians to keep abreast of new developments. Although guidelines for the diagnosis and management of patients with hyperthyroidism have been published previously by both the American Thyroid Association (ATA) and American Association of Clinical Endocrinologists (AACE), in conjunction with guidelines for the treatment of hypothyroidism (1,2), both associations determined that thyrotoxicosis represents a priority area in need of updated evidence based practice guidelines.

The target audience for these guidelines includes general and subspeciality physicians and others providing care for patients with thyrotoxicosis. In this document, we outline what we believe is current, rational, and optimal medical practice. It is not the intent of these guidelines to replace clinical judgment, individual decision making, or the wishes of the patient or family. Rather, each recommendation should be evaluated in light of these elements in order that optimal patient care is delivered. In some circumstances, it may be apparent that the level of care required may be best provided in centers where there is specific expertise, and that referral to such centers should be considered.