Endocrine Division, Harvard Vanguard Medical Associates, Boston, Massachusetts 02215, USA.
Thyroid. 2012 Dec;22(12):1200-35. doi: 10.1089/thy.2012.0205. Epub 2012 Nov 6.
Hypothyroidism has multiple etiologies and manifestations. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions. This paper describes evidence-based clinical guidelines for the clinical management of hypothyroidism in ambulatory patients.
The development of these guidelines was commissioned by the American Association of Clinical Endocrinologists (AACE) in association with American Thyroid Association (ATA). AACE and the ATA assembled a task force of expert clinicians who authored this article. The authors examined relevant literature and took an evidence-based medicine approach that incorporated their knowledge and experience to develop a series of specific recommendations and the rationale for these recommendations. The strength of the recommendations and the quality of evidence supporting each was rated according to the approach outlined in the American Association of Clinical Endocrinologists Protocol for Standardized Production of Clinical Guidelines-2010 update.
Topics addressed include the etiology, epidemiology, clinical and laboratory evaluation, management, and consequences of hypothyroidism. Screening, treatment of subclinical hypothyroidism, pregnancy, and areas for future research are also covered.
Fifty-two evidence-based recommendations and subrecommendations were developed to aid in the care of patients with hypothyroidism and to share what the authors believe is current, rational, and optimal medical practice for the diagnosis and care of hypothyroidism. A serum thyrotropin is the single best screening test for primary thyroid dysfunction for the vast majority of outpatient clinical situations. The standard treatment is replacement with L-thyroxine. The decision to treat subclinical hypothyroidism when the serum thyrotropin is less than 10 mIU/L should be tailored to the individual patient.
甲状腺功能减退症有多种病因和表现。适当的治疗需要准确的诊断，并受并存的医疗条件的影响。本文描述了针对门诊患者甲状腺功能减退症的临床管理的循证临床指南。
这些指南的制定是由美国临床内分泌医师协会（AACE）与美国甲状腺协会（ATA）联合委托的。AACE 和 ATA 组建了一个由专家临床医生组成的工作组，负责撰写本文。作者检查了相关文献，并采用循证医学方法，结合他们的知识和经验，制定了一系列具体建议和这些建议的依据。根据美国临床内分泌医师协会标准化临床指南制定协议-2010 年更新中概述的方法，对建议的强度和支持每项建议的证据质量进行了评估。
讨论的主题包括甲状腺功能减退症的病因、流行病学、临床和实验室评估、管理以及后果。还涵盖了筛查、亚临床甲状腺功能减退症的治疗、妊娠以及未来研究的领域。
制定了 52 条基于证据的建议和子建议，以帮助治疗甲状腺功能减退症患者，并分享作者认为当前、合理和最佳的诊断和治疗甲状腺功能减退症的医疗实践。血清促甲状腺激素是绝大多数门诊临床情况下原发性甲状腺功能障碍的最佳筛查试验。标准治疗是用 L-甲状腺素替代。当血清促甲状腺激素小于 10mIU/L 时，是否治疗亚临床甲状腺功能减退症应根据个体患者的情况而定。
