Today, I was reminded by my Medscape News Diabetes and Endocrinology about the American Association of Clinical Endocrinologists (AACE) and the American Thyroid Association (ATA) Guidelines to treat hypothyroidism that came out in the Nov/Dec 2012 issue of Endocrine Practice.
This guideline paper helped to validate what I have been saying. Specifically, that the TSH is the best screening test for hypothyroidism, levothyroxine is the standard treatment, and that treating subclinical hypothyroidism with TSH higher than normal, but less than 10, should be patient-specific.
In the United States, the most common cause of an underactive thyroid is Hashimoto's thyroiditis, which is an auto-immune condition. It affects about 0.3% of the general population, and women 5-10 times more often than men. Sometimes it causes an enlarged gland, but not always. About 75% of the time, antibodies (anti-TSH, anti-TPO) are positive, and once they are, they usually remain that way, so repeating thyroid antibody titers is generally not useful.
Determining who has hypothyroidism is important, but the manner of screening in terms of whether to do it at all (Royal College of Physicians of London doesn't feel it's important in a healthy adult population), to more aggressive screening recommendations of the ATA of both men and women over the age of 35 should be screened every 5 years.
Overall, there were 52 recommendations, and I'll try to cover a few more tomorrow, as it's getting quite late.
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