title: Clinical practice guidelines for the management of hypothyroidism.
abstract: BACKGROUND
  Hypothyroidism has long been known for its effects on different organ systems, leading to hypometabolism. However, subclinical hypothyroidism, its most prevalent form, has been recently related to cardiovascular risk and also to maternal-fetal complications in pregnant women.
  
  
  OBJECTIVE
  In these clinical practice guidelines, several aspects of this field have been discussed with the clear objectives of helping physicians treat patients with hypothyroidism, and of sharing some of our Latin American-based clinical experience.
  
  
  METHODS
  The Latin American Thyroid Society commissioned a Task Force on Hypothyroidism to develop evidence-based clinical guidelines on hypothyroidism. A systematic review of the available literature, focused on the primary databases of MedLine/PubMed and Lilacs/SciELO was performed. Filters to assess methodological quality were applied to select the best quality studies. The strength of recommendation on a scale from A-D was based on the Oxford Centre for Evidence--based Medicine, Levels of Evidence 2009, allowing an unbiased opinion devoid of subjective viewpoints. The areas of interest for the studies comprised diagnosis, screening, treatment and a special section for hypothyroidism in pregnancy.
  
  
  RESULTS
  Several questions based on diagnosis, screening, treatment of hypothyroidism in adult population and specifically in pregnant women were posed. Twenty six recommendations were created based on the answers to these questions. Despite the fact that evidence in some areas of hypothyroidism, such as therapy, is lacking, out of 279 references, 73% were Grade A and B, 8% Grade C and 19% Grade D.
  
  
  CONCLUSIONS
  These evidence-based clinical guidelines on hypothyroidism will provide unified criteria for management of hypothyroidism throughout Latin America. Although most of the studies referred to are from all over the world, the point of view of thyroidologists from Latin America is also given.
authors.affiliation: Dr. Cesar Milstein Hospital, Buenos Aires, Argentina. gbrenta@gmail.com
authors.forename: Gabriela
authors.initials: G
authors.lastname: Brenta
authors.forename: Mario
authors.initials: M
authors.lastname: Vaisman
authors.forename: José Augusto
authors.initials: JA
authors.lastname: Sgarbi
authors.forename: Liliana Maria
authors.initials: LM
authors.lastname: Bergoglio
authors.forename: Nathalia Carvalho de
authors.initials: NC
authors.lastname: Andrada
authors.forename: Pedro Pineda
authors.initials: PP
authors.lastname: Bravo
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Orlandi
authors.forename: Hans
authors.initials: H
authors.lastname: Graf
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002648:Child; D050171:Dyslipidemias; D019317:Evidence-Based Medicine / Q000592:standards; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000175:diagnosis / Q000517:prevention & control*; D008297:Male; D011247:Pregnancy; D037841:Pregnant People; D013961:Thyroid Gland / Q000000981:diagnostic imaging*; D013972:Thyrotropin / Q000097:blood*; D013974:Thyroxine / Q000097:blood*; D014463:Ultrasonography
chemical_list: D013972:Thyrotropin; D013974:Thyroxine