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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

JAMA. 1995;273(10):808-812.

Abstract
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)

Author Affiliations
From the Division of Endocrinology, Diabetes, and Hypertension, University of Southern California School of Medicine, Los Angeles (Dr Singer); Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Md (Drs Cooper and Ladenson); Division of Endocrinology, Mt Sinai Hospital, Baltimore, Md (Dr Cooper); Division of Endocrinology, University of Miami (Fla) School of Medicine (Dr Levy); Division of Endocrinology, University of Massachusetts Medical School, Worcester (Dr Braverman); Thyroid Unit, Massachusetts General Hospital, Boston (Dr Daniels); Division of Endocrinology, University of California, San Francisco School of Medicine (Dr Greenspan); Division of Nuclear Medicine, Stanford (Calif) University School of Medicine (Dr McDougall); and Marshfield (Wis) Clinic (Dr Nikolai).

Footnotes
Reprint requests to University of Southern California, 1355 S San Pablo St, Room 120, Los Angeles, CA 90033 (Dr Singer).

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