Peter A. Singer, MD; David S. Cooper, MD; Elliot G. Levy, MD; Paul W. Ladenson, MD; Lewis E.
Braverman, MD; Gilbert Daniels, MD; Francis S. Greenspan, MD; I. Ross McDougall, MB, ChB, PhD;
Thomas F. Nikolai, MD

Objective.--To develop a set of minimum clinical guidelines for use by primary care physicians in the
evaluation and management of patients with hyperthyroidism and hypothyroidism.

Participants.--Guidelines were developed by a nine-member ad hoc Standards of Care Committee of the
American Thyroid Association (the authors of this article). The participants were selected by the
committee chair and the president of the American Thyroid Association on the basis of their clinical
experience. The committee members represented different geographic areas within the United States, in
order to take into account different practice styles.

Evidence.--Guidelines were developed on the basis of expert opinion of the participants, as well as on
available published information.

Consensus Process.--Input was obtained from all of the participants, each of whom wrote an initial
section of the document. A complete draft document was then written by three participants (P.A.S.,
D.S.C., and E.G.L.) and resubmitted to the entire committee for revision. The revised document was then
submitted to the entire membership of the American Thyroid Association for written comments, which
were then reviewed (mainly by P.A.S., D.S.C., and E.G.L.). Many of the suggestions of the American
Thyroid Association members were incorporated into the final draft, which was then approved by the
Executive Council of the American Thyroid Association. The entire process, from initial drafts to final
approval, took approximately 18 months.

Conclusions.--A set of minimum clinical guidelines for the diagnosis and treatment of hyperthyroidism
and hypothyroidism were developed by consensus of a group of experienced thyroidologists. The
guidelines are intended to be used by physicians in their care of patients with thyroid disorders, with the
expectation that more effective care can be provided, and at a cost savings.
(JAMA. 1995;273:808-812)

HYPERTHYROIDISM and hypothyroidism are highly prevalent conditions that usually come to the
attention of the primary care physician first. In order to provide physicians practice guidelines for patients
with thyroid disorders, the American Thyroid Association created an ad hoc Standards of Care
Committee, charged with developing such guidelines, following the procedure outlined in the abstract.
These guidelines were felt by the leadership of the American Thyroid Association to be an important step,
hopefully leading to more cost-effective, as well as clinically appropriate, care. The clinical guidelines
were designed to provide latitude in decision making, taking into consideration varying practice styles, as
well as differences in patient presentations.