Division of Endocrinology, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA.
Endocr Pract. 2011 May-Jun;17(3):456-520. doi: 10.4158/ep.17.3.456.
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.
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.
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.
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.
甲状腺功能亢进症有多种病因、表现和潜在的治疗方法。适当的治疗需要准确的诊断，并受并存的医疗状况和患者偏好的影响。本文描述了针对甲状腺功能亢进症管理的循证临床指南，这些指南对普通科医生和亚专科医生以及为该病症患者提供护理的其他人员有用。
这些指南的制定是由美国甲状腺协会与美国临床内分泌医师协会联合委托的。美国甲状腺协会和美国临床内分泌医师协会召集了一个由专家临床医生组成的工作组来撰写本报告。工作组使用系统的 PubMed 搜索来审查相关文献，并辅以其他已发表的材料。采用循证医学方法，结合专家组的知识和经验来编写文本和一系列具体建议。根据推荐分级、评估、发展和评估（Grading of Recommendations, Assessment, Development, and Evaluation）小组推荐的方法，对建议的强度和支持每个证据的质量进行了评级。
涵盖的临床主题包括甲状腺功能亢进症的初始评估和管理；放射性碘、抗甲状腺药物或手术治疗格雷夫斯病；放射性碘或手术治疗毒性多结节性甲状腺肿或毒性腺瘤；儿童、青少年或孕妇的格雷夫斯病；亚临床甲状腺功能亢进症；格雷夫斯眼病患者的甲状腺功能亢进症；以及其他各种原因的甲状腺功能亢进症的管理。
制定了 100 条基于证据的建议，以帮助甲状腺功能亢进症患者的护理，并分享工作组认为是当前、合理和最佳的医疗实践。
