Consensus Statement for Good Practice and Audit Measures in the Management
of Hypothyroidism and Hyperthyroidism
Summary of Good Practice for Purchasers
Thyroid disorders are among the most prevalent of medical conditions and
increase with age.
Screening the healthy adult population for thyroid dysfunction is unjustified.
The diagnosis of thyroid dysfunction must be confirmed biochemically.
Each district general hospital should have a specialist in thyroid disorders
with access to an experienced thyroid surgeon and thyroid disease register.
Patients with hypothyroidism need referral only in certain circumstances.
Serum thyroid stimulating hormone concentration should be measured yearly
to ensure compliance with the treatment of hypothyroidism.
All patients with hyperthyroidism should be referred to a specialist at
diagnosis.
In Graves’ disease, carbimazole is the medical treatment of choice via
either a titrating or block-replace regimen.
Radioiodine is indicated in most types of hyperthyroidism but must be
given with caution in the presence of active Graves’ ophthalmopathy.
Thyroid surgery by an experienced surgeon is an alternative method of
treating hyperthyroid patients.
All patients treated with radioiodine or partial thyroidectomy should
have a yearly check of thyroid function.
M P J Vanderpump, J A O Ahlquist, J A Franklyn, R N Claayton,
on behalf of a working group of the Research Unit of the Royal College of Physicians
of London, the Endocrinology and Diabetes Committee of the Royal College of
Physicians of London, the Society of Endocrinology, and the British
Thyroid Foundation.
The full report is published in the British Medical Journal, Volume 313,
31 August 1996.