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Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association

Garber, Jeffrey R., Cobin, Rhoda H., Gharib, Hossein, Hennessey, James V., Klein, Irwin, Mechanick, Jeffrey I., Pessah-Pollack, Rachel, Singer, Peter A. +1 more·2012·Endocrine Practice
DOI 10.4158/ep12280.gl
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Abstract

Objective 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.Methods 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.Results 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.Conclusions 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.

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  • The NICE approach is a compromise between Canadian guidance, which recommends against screening for thyroid dysfunction in asymptomatic, non-pregnant adults, and American Thyroid Association guidance, which recommends aggressive case finding in patients with associated autoimmune diseases, first-degree relatives with autoimmune diseases, previous neck irradiation, and those with psychiatric

    “This approach is a compromise between the Canadian guidance, which recommends against screening for thyroid dysfunction in asymptomatic, non-pregnant adults, 108 and the American Thyroid Association guidance, which recommends aggressive case finding in patients with associated autoimmune diseases, firstdegree relatives with autoimmune diseases, previous neck irradiation, and those with psychiatric”

    From Hypothyroidism (2024) · cites this paper as [109]

  • The 2012 ATA guidelines recommended an initial levothyroxine dose of 25 to 50 μg/d for patients with cardiovascular disease.

    “The 2012 ATA guidelines 31 recommended an initial levothyroxine dose of 25 μg/d to 50 μg/d for patients with cardiovascular disease.”

    From Hypothyroidism: A Review (2025) · cites this paper as [31]

  • In severe hypothyroidism, chronic and pericardial interstitial edema with reduced myocardial contractility can progress to cardiac tamponade.

    “In the most severe forms, chronic and pericardial interstitial edema, associated with reduced myocardial contractility, can progress to cardiac tamponade [1, 3].”

    From Thyroid and heart, a clinically relevant relationship (2021) · cites this paper as [3]

  • Overt hypothyroidism causes interstitial accumulation of glycosaminoglycans that attracts water from the endovascular compartment, reducing effectiveness of medical therapy.

    “Overt hypothyroidism causes an interstitial accumulation of glycosaminoglycans that attracts water from the endovascular compartment, reducing the effectiveness of medical therapy.”

    From Thyroid and heart, a clinically relevant relationship (2021) · cites this paper as [3]

  • Overt hypothyroidism is often associated with early diastolic dysfunction, which together with diastolic hypertension and/or other risk factors can lead to difficult-to-treat heart failure.

    “Echocardiographic studies have shown that overt hypothyroidism is often associated with early diastolic dysfunction which, together with the frequent occurrence of diastolic hypertension and/or other risk factors in these patients, can lead to difficult-to-treat heart failure [1, 3].”

    From Thyroid and heart, a clinically relevant relationship (2021) · cites this paper as [3]

Cites

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Research works printed but not linked: 6

  1. Garcia, 1995, American Association of Clinical Endocrinologists clinical practice guidelines for the evaluation and treatment of hyperthyroidism and hypothyroidism, Endocr Pract, 1, 54
  2. Boothby, 1929, Normal values of basal or standard metabolism. A modification of the Dubois standards, Am J Physiol, 90, 290
  3. Means, 1940, The pituitary type of myxedema or Simmond's disease masquerading as myxedema, Trans Assoc Am Physicians, 55, 32
  4. Lamson, 2004, Quantitation of a substantial reduction in levothyroxine (T4) reduction by food [abstract], Thyroid, 14, 876
  5. Yu X, Shan Z, Teng W, et al. A prospective study on impact of subclinical hypothyroidism during pregnancy receiving levothyroxine treatment or not on neuropsychological development of the offspring. ITC 2010-1037. Presented at: 14th International Thyroid Conference; September 11-16, 2010; Paris, France. [EL2]
  6. Gharib, 1999, Subclinical hypothyroidism during pregnancy: position statement from the American Association of Clinical Endocrinologists, Endocr Pract, 5, 367

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Authors
Garber, J. R., Cobin, R. H., Gharib, H., Hennessey, J. V., Klein, I., Mechanick, J. I., Pessah-Pollack, R., Singer, P. A., & Woeber, K. A.
Affiliations
  • Beth Israel Deaconess Medical Center (US)
  • Mayo Clinic (US)
  • North Shore University Hospital (US)
  • Mount Sinai Hospital (US)
  • University of Southern California (US)
  • University of California, San Francisco (US)
Corresponding author
Garber, Jeffrey R.
ORCID
Venue
Endocrine Practice
Publisher
Elsevier BV
Published
2012-11
Volume
18
Issue
6
Pages
988-1028
ISSN
1530-891X (ISSN-L)
DOI
10.4158/ep12280.gl
OpenAlex
W2530107877
Semantic Scholar
0721e97fb534936b43ee3dc9c98462f98caef7e1
Cited by
1,567
References
315
Citations by year
2026: 77 · 2025: 92 · 2024: 98 · 2023: 82 · 2022: 97 · 2021: 142 · 2020: 143 · 2019: 143 · 2018: 149 · 2017: 143 · 2016: 98 · 2015: 124 · 2014: 104 · 2013: 66 · 2012: 5
FWCI
68.72
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Endocrine Practice (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
Keywords
hypothyroidism, subclinical hypothyroidism, levothyroxine, thyroid screening, serum thyrotropin, hypothyroidism diagnosis, hypothyroidism management, pregnancy, outpatient care
MeSH terms
Humans, Hypothyroidism, Societies, Medical, Thyrotropin, Thyroxine, United States, Evidence-Based Medicine, Disease Management

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