In France, thyroid dysfunctions affect about 2% of the population. Some suffer from hypothyroidism, linked to a decrease or absence of thyroid hormone production, and others have hyperthyroidism, linked to an excess of thyroid hormones.

Tuesday, March 14, the High Authority for Health (HAS) published new recommendations to improve the management of patients with hyper or hypothyroidism. Indeed, the HAS points to monitoring and care that “are not always optimal”. First, she recommends adapt the support and the diagnosis of hypothyroidism to the patient profile. In the event of symptoms, the HAS recommends carrying out biological analyzes in sequence in order to avoid repeated and useless blood tests for the person. In the official document, the HAS recalls that imaging examinations are not useful in the management of hypothyroidism, except in certain indications.

For patients over 65, age does not justify performing a TSH assay to detect hypothyroidism. An examination is only recommended “if clinical signs suggestive of hypothyroidism, upon discovery of recent cognitive decline, if known neurocognitive disorders worsen in an unexplained manner or in the event of treatment with amiodarone”. Concerning pregnant women or with a pregnancy project, they must consult quickly as soon as they become aware of the pregnancy. “The doses of levothyroxine must then be increased by 20% to 30% at the start of pregnancy. In the event that the patient does not have rapid access to a doctor and if she does not have a prescription drawn up at the advance with increased doses, she must increase her doses of levothyroxine on her own while waiting for the consultation”, recommends the HAS.

What about hyperthyroidism? The High Authority for Health recalls that the confirmation of the diagnosis is based on the TSH assay alone. “Other biological examinations can be carried out in cascade when the result of the TSH assay is abnormal, to complete the diagnosis and determine the cause of the disease (Graves’ disease, toxic adenoma, etc.), adds the HAS. Moreover, the initiation of treatment is not systematic and depends on the context. Finally, it is recalled that surgery in the event of hyperthyroidism should only be performed as a last resort and only in the presence of a large compressive goitre or in the event of suspicion of malignancy.