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AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE EVALUATION AND TREATMENT OF HYPERTHYROIDISM AND HYPOTHYROIDISM
AACE Thyroid Task Force Chairman H. Jack Baskin, MD, MACE Committee Members Rhoda H. Cobin, MD, FACE Daniel S. Duick, MD, FACE Hossein Gharib, MD, FACE Richard B. Guttler, MD, FACE Michael M. Kaplan, MD, FACE Robert L. Segal, MD, FACEReviewers Jeffrey R. Garber, MD, FACE Carlos R. Hamilton, Jr., MD, FACE Yehuda Handelsman, MD, FACP, FACE Richard Hellman, MD, FACP, FACE John S. Kukora, MD, FACS, FACE Philip Levy, MD, FACE Pasquale J. Palumbo, MD, MACE Steven M. Petak, MD, JD, FACE Herbert I. Rettinger, MD, MBA, FACE Helena W. Rodbard, MD, FACE F. John Service, MD, PhD, FACE, FACP, FRCPC Talla P. Shankar, MD, FACE Sheldon S.Stoffer, MD, FACE John B. Tourtelot, MD, FACE, CDR, USN

2006 AMENDED VERSION This amended version reflects a clarification to specify pertechnetate as the compound attached to 99mTc.

ENDOCRINE PRACTICE Vol 8 No. 6 November/December 2002 457

AACE Guidelines
AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE EVALUATION AND TREATMENT OFHYPERTHYROIDISM AND HYPOTHYROIDISM

ABSTRACT These clinical practice guidelines summarize the recommendations of the American Association of Clinical Endocrinologists for the diagnostic evaluation of hyperthyroidism and hypothyroidism and for treatment strategies in patients with these disorders. The sensitive thyroidstimulating hormone (TSH or thyrotropin) assay has become the single best screening testfor hyperthyroidism and hypothyroidism, and in most outpatient clinical situations, the serum TSH is the most sensitive test for detecting mild thyroid hormone excess or deficiency. Therapeutic options for patients with Graves’ disease include thyroidectomy (rarely used now in the United States), antithyroid drugs (frequently associated with relapses), and radioactive iodine (currently thetreatment of choice). In clinical hypothyroidism, the standard treatment is levothyroxine replacement, which must be tailored to the individual patient. Awareness of subclinical thyroid disease, which often remains undiagnosed, is emphasized, as is a system of care that incorporates regular follow-up surveillance by one physician as well as education and involvement of the patient. (Endocr Pract.2002;8:457469) Abbreviations: AACE = American Association of Clinical Endocrinologists; RIA = radioimmunoassay; T3 = triiodothyronine; T4 = thyroxine; TRAb = thyrotropin receptor antibodies; TSH = thyroid-stimulating hormone (thyrotropin); TSI = thyroid-stimulating immunoglobulins MISSION STATEMENTS Guidelines Mission Statement The purpose of these guidelines is to present a framework for the diagnosis,treatment, and follow-up of patients with hyperthyroidism and hypothyroidism. These thyroid guidelines address the difficulties involved in diagnosing thyroid disease and offer a system of care that should improve outcomes and reduce costs. The American Association of Clinical Endocrinologists (AACE) advocates a continuum of care by one physician with expertise in the diagnosis and treatment ofthyroid disease and

follow-up conducted at regular intervals throughout the course of the patient’s disease. Public Service Mission Statement Since the original AACE Thyroid Guidelines were published in 1995 (1), the sensitive thyroid-stimulating hormone (TSH or thyrotropin) assay has become the primary test to diagnose and treat thyroid disease, and subclinical thyroid disease has been moreprecisely defined and diagnosed. Subclinical hyperthyroidism has been shown to affect the health of untreated patients adversely, and subclinical hypothyroidism may also have important health consequences. Patients with subclinical hyperthyroidism are often those who have received excessive amounts of thyroid hormone, which may result in an accelerated rate of bone loss—a frequent problem in the...
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