Management of thyroid disease: NICE guidelines

A summary of a recent guideline from the National Institute for Health and Care Excellence (NICE), published online in The BMJ, recommendations are presented for the assessment and management of thyroid disease.

Thyroid disease, comprising thyroid dysfunction and enlargement, is common and often identified in primary care. Conditions causing thyroid dysfunction can be broadly divided into those that result in thyroid gland under-activity (overt and subclinical hypothyroidism) or overactivity (thyrotoxicosis). Hypothyroidism is usually managed by general practitioners.

In the summary, Melina Vasileiou, from the Royal College of Physicians in London, and colleagues present some of the most recent NICE recommendations on thyroid disease assessment and management, which are based on systematic reviews of the best available clinical evidence.

Key recommendations-

• A starting levothyroxine dose of 1.6 μg/kg/day (rounded to the nearest 25 μg) is recommended for adults under 65 years old with primary hypothyroidism and no history of cardiovascular disease
• A starting levothyroxine dose of 25-50 μg/day with titration is recommended for adults aged 65 and over and adults with a history of cardiovascular disease
• Natural thyroid extract is not recommended and liothyronine (alone or in combination with levothyroxine) is not routinely recommended for treating people with primary hypothyroidism
• Aim to maintain thyroid-stimulating hormone (TSH) levels within the reference range when treating primary hypothyroidism with levothyroxine; if symptoms persist consider adjusting the dose of levothyroxine further to achieve optimal wellbeing, but avoid using doses that cause TSH suppression or thyrotoxicosis
• Radioactive iodine is recommended as first-line treatment for thyrotoxicosis with hyperthyroidism unless antithyroid drugs are likely to achieve remission or it is unsuitable

"There has been uncertainty in the U.K. about the best treatment for hyperthyroidism despite radioactive iodine being the most common first-line treatment for this condition in the U.S.," a coauthor said in a statement. "We are very pleased to have been able to work with NICE to provide clear new guidance which we hope will improve outcomes for patients with this condition." 

For more details click on the link: DOI: https://doi.org/10.1136/bmj.m41