# ] New guidelines outline diagnosis, management of hyperthyroidism(GOOD NEWS)



## AZgirl (Nov 11, 2010)

The American Association of Clinical Endocrinologists and the American Thyroid Association have collaborated to release new guidelines outlining the appropriate management of patients with hyperthyroidism and other causes of thyrotoxicosis.

"Our goal with these new guidelines is to provide every doctor treating thyroid patients the tools they need to provide the most effective care," AACE president Yehuda Handelsman, MD, said in a press release. "Today, we have access to more clinical research data than ever before, and these guidelines help put that knowledge in the physicians' hands."

Key updates to optimize care

Important updates address the treatment of Graves' disease, specifically regarding various therapeutic options, according to Rebecca S. Bahn, MD, chairwoman of the joint task force charged with developing the guidelines.

"The new guidelines review well-established treatment options for Graves' disease while emphasizing how and when physicians should take their patients' preference into consideration," Jeffrey R. Garber, MD, president-elect of the American College of Endocrinology and an Endocrine Today Editorial Board member, said in a press release.

According to Bahn, another major update is the task force's decision to not endorse specific therapies for Graves' disease over others.

"The guidelines state that [radioactive iodine therapy, antithyroid medication and thyroidectomy] are all acceptable treatment options," Bahn, professor of medicine and consultant in endocrinology, metabolism and nutrition at the Mayo Clinic, Rochester, Minn., told Endocrine Today. "This is a significant change because past guidelines in the United States have been more in favor of radioactive iodine as the first-line treatment for every patient. We're taking a bit of a different tack."

The task force takes a stronger stance on recommended antithyroid medications. If medication is a patient's therapy of choice, the guidelines strongly suggest that physicians prescribe methimazole or carbimazole outside of the United States instead of propylthiouracil (PTU) because previous research has linked PTU to severe liver failure. This recommendation, however, does not hold in every instance, Bahn said. Methimazole has been associated with birth defects; therefore, the task force recommends that pregnant women use PTU during the first trimester and then switch to methimazole during the second and third trimesters and postpartum if hyperthyroidism persists. Further, because severe liver failure related to PTU use is more common in children, the guidelines strongly recommend that methimazole, instead of PTU, be used in the pediatric population with Graves' disease.

Other updates address treating hyperthyroidism related to nodular thyroid disease, including multinodular, goiter or toxic adenoma. Currently, radioactive iodine and thyroidectomy are the most popular treatment options, but the guidelines also suggest that long-term, low-dose methimazole may be appropriate in some instances. Generally, this suggestion is limited to elderly patients or those with shorter life expectancies.

The task force also provided recommendations that patients with active moderate to severe Graves' ophthalmopathy be treated with methimazole or surgery, and not radioactive iodine. The guidelines note, however, that those with mild disease who smoke and choose radioactive iodine treatment should take concurrent corticosteroids or consider surgery or antithyroid medication instead.

New directions

The new guidelines are patient-centric and emphasize that decisions regarding treatment of hyperthyroidism should be made jointly by the patient and the physician with consideration of both the specific clinical setting and the patient's preference, Bahn said. She suggested providing a copy of the guidelines to interested patients in appropriate situations.

"Although these guidelines offer recommendations and educated information for clinical practice, they are just guidelines," Bahn said. "The final decision for all of these things depends on a conversation between the patient and the physician, which requires informed decision-making on both sides." - by Melissa Foster

http://www.endocrinetoday.com/view.aspx?rid=85888

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