Cited by 427Thyroid Disorders and TreatmentsClinical practice guidelines implementationThyroid and Parathyroid Surgery

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Treatment Guidelines for Patients With Hyperthyroidism and Hypothyroidism

Singer, Peter A.·1995·JAMA: The Journal of the American Medical Association

DOI 10.1001/jama.1995.03520340064038

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Abstract

Objective To develop a set of minimum clinical guidelines for use by primary care physicians in the evaluation and management of patients with hyperthyroidism and hypothyroidism. Participants Guidelines were developed by a nine-member ad hoc Standards of Care Committee of the American Thyroid Association (the authors of this article). The participants were selected by the committee chair and the president of the American Thyroid Association on the basis of their clinical experience. The committee members represented different geographic areas within the United States, in order to take into account different practice styles. Evidence Guidelines were developed on the basis of expert opinion of the participants, as well as on available published information. Consensus process Input was obtained from all of the participants, each of whom wrote an initial section of the document. A complete draft document was then written by three participants (P.A.S., D.S.C., and E.G.L.) and resubmitted to the entire committee for revision. The revised document was then submitted to the entire membership of the American Thyroid Association for written comments, which were then reviewed (mainly by P.A.S., D.S.C., and E.G.L.). Many of the suggestions of the American Thyroid Association members were incorporated into the final draft, which was then approved by the Executive Council of the American Thyroid Association. The entire process, from initial drafts to final approval, took approximately 18 m…

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Background
THYROID DISEASE IN WOMEN
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Method
Management of hypothyroidism with combination thyroxine (T4) and triiodothyronine (T3) hormone replacement in clinical practice: a review of suggested guidance
Dayan, C., & Panicker, V. (2018) · Thyroid Research · doi:10.1186/s13044-018-0045-x · Cited by 62
Treatment of hyperthyroidism with radioactive iodine.
Kaplan, M. M., Meier, D. A., & Dworkin, H. J. (1998) · Endocrinology and metabolism clinics of North America (Print) · doi:10.1016/s0889-8529(05)70307-8 · Cited by 62
Occupational pesticide exposure and subclinical hypothyroidism among male pesticide applicators
Lerro, C. C., Freeman, L. E. B., DellaValle, C. T., Kibriya, M. G., Aschebrook‐Kilfoy, B., Jasmine, F., Koutros, S., Parks, C. G., Sandler, D. P., Alavanja, M. C. R., et al. (2017) · Occupational and Environmental Medicine · doi:10.1136/oemed-2017-104431 · Cited by 62
Exposure to Arsenic in urban and rural areas and effects on thyroid hormones
Ciarrocca, M., Tomei, F., Caciari, T., Cetica, C., Andrè, J., Fiaschetti, M., Schifano, M., Scala, B., Scimitto, L., Tomei, G., et al. (2012) · Inhalation Toxicology · doi:10.3109/08958378.2012.703251 · Cited by 61
“Altered carrier protein concentrations induce changes in total T4 and T3 levels, while fT4 and fT3 values exhibit little variance; thus, fT4 and fT3 measurements are more highly correlated with the thyroid status than total T4 and total T3 measurements (Singer et al., 1995).”
Background
Thyroid Disorders in Elderly Patients
Rehman, S., Cope, D. W., Senseney, A., & Brzezinski, W. (2005) · Southern medical journal (Birmingham, Ala. Print) · doi:10.1097/01.smj.0000152364.57566.6d · Cited by 61
“Once a steady state of FTI and TSH levels has been achieved, patients should be monitored every 6 to 12 months for clinical response to the treatment, adherence to medication, and observation of drug interactions.(19) Education of the patient and family is very important, since in many elderly individuals coexisting m…”
Background
Arterial embolization: a novel approach to thyroid ablative therapy for Graves' disease.
Xiao, H.-P., Zhuang, W., Wang, S., Yu, B.-J., Chen, G.-R., Zhou, M., & Wong, N. (2002) · Journal of Clinical Endocrinology and Metabolism · doi:10.1210/jcem.87.8.8723 · Cited by 61
“include: antithyroid drugs, radioiodine, or surgery (7, 8).”
The clinical importance of laboratory reasoning.
Plebani, M. (1999) · Clinica chimica acta; international journal of clinical chemistry · doi:10.1016/s0009-8981(98)00196-x · Cited by 58
Radioiodine Therapy for Graves' Disease: Case Selection and Restrictions Recommended to Patients in North America
Wartofsky, L. (1997) · Thyroid · doi:10.1089/thy.1997.7.213 · Cited by 53
Treatment of clinical hypothyroidism with thyroxine and triiodothyronine: a literature review and metaanalysis
Joffe, R. T., Brimacombe, M., Levitt, A. J., & Stagnaro-Green, A. (2007) · Psychosomatics · doi:10.1176/appi.psy.48.5.379 · Cited by 57
Effect of long-term l-thyroxine treatment on bone mineral density in young adults with congenital hypothyroidism
Salerno, M., Lettiero, T., Esposito-Del Puente, A., Esposito, V, Capalbo, D., Carpinelli, A., Padula, S., & Del Puente, A. (2004) · European Journal of Endocrinology · doi:10.1530/eje.0.1510689 · Cited by 56
Adverse event reporting in patients treated with levothyroxine: results of the pharmacovigilance task force survey of the American Thyroid Association, American Association of Clinical Endocrinologists, and the Endocrine Society
Hennessey, J. V., Malabanan, A. O., Haugen, B. R., & Levy, E. G. (2010) · Endocrine Practice · doi:10.4158/ep0362.or · Cited by 56
Dissatisfaction with thyroxine therapy — could the patients be right?
Walsh, J. P. (2002) · Current Opinion in Pharmacology · doi:10.1016/s1471-4892(02)00209-6 · Cited by 47
Radioiodine or Surgery for Toxic Thyroid Adenoma: Dissecting an Important Decision. A Cost-Effectiveness Analysis
Vidal-Trecan, G. M., Stahl, J. E., & Eckman, M. H. (2004) · Thyroid · doi:10.1089/thy.2004.14.933 · Cited by 53
Subclinical Hypothyroidism
Cooper, D. S. (2001) · New England Journal of Medicine · doi:10.1056/nejm200107263450406 · Cited by 530
Drug discontinuation after treatment with minimum maintenance dose of an antithyroid drug in Graves' disease: a retrospective study on effects of treatment duration with minimum maintenance dose on lasting remission
Konishi, T., Okamoto, Y., Ueda, M., Fukuda, Y., Harusato, I., Tsukamoto, Y., & Hamada, N. (2011) · Endocrine Journal · doi:10.1507/endocrj.k10e-262 · Cited by 52
Graves' Disease in Childhood
Kraiem, Z., & Newfield, R. (2001) · Journal of Pediatric Endocrinology & Metabolism (JPEM) · doi:10.1515/jpem.2001.14.3.229 · Cited by 51
The Role of Nuclear Medicine in the Clinical Management of Benign Thyroid Disorders, Part 1: Hyperthyroidism
Mariani, G., Tonacchera, M., Grosso, M., Orsolini, F., Vitti, P., & Strausś, H. W. (2020) · Journal of Nuclear Medicine · doi:10.2967/jnumed.120.243170 · Cited by 77
“Learning Objectives: On successful completion of this activity, participants should be able to (1) acquire knowledge on the clinical manifestations and underlying pathophysiology of the different forms of hyperthyroidism; (2) understand how to interpret ultrasound imaging and radionuclide evaluation in patients with h…”
Background
The Management of Subclinical Hyperthyroidism by Thyroid Specialists
McDermott, M. T., Woodmansee, W. W., Haugen, B. R., Smart, A., & Ridgway, E. C. (2003) · Thyroid · doi:10.1089/10507250360731532 · Cited by 45
Thyroid spermatogenesis and male infertility
Agarwal, A. K. (2011) · Frontiers in Bioscience-Elite · doi:10.2741/e292 · Cited by 46
Toxic Nodular Goiter and Cancer: A Compelling Case for Thyroidectomy
Smith, J., Chen, X., Schneider, D. F., Nookala, R., Broome, J. T., Sippel, R., Chen, H., & Solórzano, C. (2013) · Annals of Surgical Oncology · doi:10.1245/s10434-012-2725-4 · Cited by 48
Efficacy of single daily dosage of methimazole vs. propylthiouracil in the induction of euthyroidism
Homsanit, M., Sriussadaporn, S., Vannasaeng, S., Peerapatdit, T., Nitiyanant, W., & Vichayanrat, A. (2001) · Clinical Endocrinology · doi:10.1046/j.1365-2265.2001.01239.x · Cited by 48
“As serum half-lives of both agents are quite short, i.e. 4±6 h for MMI and 75 minutes for PTU, it is suggested that both agents should be administered in divided daily doses (Burman, 1995; McKenzie & Zakarija, 1995; Utiger, 1995; Reed Larsen et al., 1998; Cooper, 2000).”
Background
CLINICAL AND LABORATORY DIAGNOSIS OF THYROTOXICOSIS
Cl, D.-A., & Surks, M. I. (1998) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/s0889-8529(05)70295-4 · Cited by 48
Intestinal permeability enhancement of levothyroxine sodium by straight chain fatty acids studied in MDCK epithelial cell line.
Pabla, D., Akhlaghi, F., & Zia, H. (2010) · European Journal of Pharmaceutical Sciences · doi:10.1016/j.ejps.2010.05.002 · Cited by 47
Comparison of single daily dose of methimazole and propylthiouracil in the treatment of Graves’ hyperthyroidism
He, C.-T., Hsieh, A.-T., Pei, D., Hung, Y.-J., Wu, L.-Y., Yang, T., Lian, W., Huang, W.-S., & Kuo, S.-W. (2004) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2004.02032.x · Cited by 47

Authors: Singer, P. A.
Affiliations: University of Southern California (US)
Corresponding author: Singer, Peter A.
Venue: JAMA: The Journal of the American Medical Association
Publisher: American Medical Association (AMA)
Published: 1995-03-08
Volume: 273
Issue: 10
Pages: 808
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.1995.03520340064038
OpenAlex: W2011275871
Cited by: 427
References: 0
Citations by year: 2026: 2 · 2025: 6 · 2024: 7 · 2023: 13 · 2022: 16 · 2021: 13 · 2020: 11 · 2019: 13 · 2018: 11 · 2017: 8 · 2016: 11 · 2015: 9 · 2014: 16 · 2013: 16 · 2012: 27
FWCI: 11.50
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
Keywords: hyperthyroidism, hypothyroidism, thyroid dysfunction, diagnosis, treatment, primary care, consensus recommendations, American Thyroid Association

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Treatment Guidelines for Patients With Hyperthyroidism and Hypothyroidism

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