Doctor checking thyroid

Guidelines for the Treatment of HypoThyroidism – Synopsis

By: Red Hot Mamas

Published: October 30, 2014

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This Post has the synopsis of the full 207 page article in October:

Guidelines for the treatment of HYPOTHYROIDISM

Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement

A number of recent advances in our understanding of thyroid physiology may shed light on why some patients feel unwell while taking levothyroxine monotherapy.

The purpose of this task force was to review the goals of levothyroxine therapy, the optimal prescription of conventional levothyroxine therapy, the sources of dissatisfaction with levothyroxine therapy, the evidence on treatment alternatives, and the relevant knowledge gaps.

We wished to determine whether there are sufficient new data generated by well-designed studies to provide reason to pursue such therapies and change the current standard of care.

Task force members identified 24 questions relevant to the treatment of hypothyroidism.
The clinical literature relating to each question was then reviewed. Clinical reviews were supplemented, when relevant, with related mechanistic and bench research literature reviews, performed by our team of translational scientists. Ethics reviews were provided, when relevant, by a bioethicist. The responses to questions were formatted, when possible, in the form of a formal clinical recommendation statement.

When responses were not suitable for a formal clinical recommendation, a summary response statement without a formal clinical recommendation was developed. For clinical recommendations, the supporting evidence was appraised, and the strength of the clinical recommendations was assessed, using the American College of Physicians (ACP) system.


We reviewed the following therapeutic categories:

i) levothyroxine therapy
ii) non-levothyroxine based thyroid hormone therapies
iii) use of thyroid hormone analogs
The second category included thyroid extracts, synthetic combination therapy, triiodothyronine therapy, and compounded thyroid hormones.


We concluded that levothyroxine should remain the standard of care for treating hypothyroidism.

We found no consistently strong evidence for the superiority of alternative preparations (e.g. levothyroxine-liothyronine combination therapy, or thyroid extract therapy, or others) over monotherapy with levothyroxine, in improving health outcomes. Some examples of future research needs include: development of superior biomarkers of euthyroidism to supplement TSH measurements, mechanistic research on serum triiodothyronine levels (including effects of age and disease status, relationship with tissue concentrations, as well as potential therapeutic targeting), and long-term outcome clinical trials testing combination therapy or thyroid extracts (including sub-group effects) Additional research is also needed to develop thyroid hormone analogs with a favorable benefit to risk profile.


For more details about the guidelines: