ATA Guidelines Updated for Managing Hyperthyroidism

Expert task force revises the 5-year old clinical care guidelines to reflect critical advances in patient management

Written by Elise Eller PhD

The American Thyroid Association (ATA) updated, evidence-based recommendations to enhance guidance to clinicians in the management of patients with hyperthyroid diseases, and other forms of thyrotoxicosis.1 The section on less common causes of thyrotoxicosis was expanded in the 2016 update.

“A wealth of new clinical information has resulted in the modification of recommendations, and the addition of new concepts,"said the ATA Task Force chair, and lead author Douglas Ross, MD, who is co-director of Thyroid Associates at Massachusetts General Hospital in Boston, MA.


Thyrotoxicosis has multiple etiologies and manifestations with many potential therapies available. However, appropriate treatment requires accurate diagnosis; and, is also influenced by coexisting medical conditions and patient preferences.

New Paradigms Reflected in the Updated Guidelines

Considerable new literature that has been amassed since the original guidelines were issued in 2011, which has necessitated the addition of four new paradigms in the following areas:

In addition to these four major changes, several other updates were made to the guidelines based on compelling new findings.  

“The endocrinologist and endocrine surgeon will be able to glean key new management choices from these guidelines that influence daily patient care,” said Mira Milas, MD, FACS, who is Chief of Endocrine Surgery, Banner – University Medical Center in Phoenix, AZ. “As an endocrine surgeon, I particularly appreciate the recommendation of supplemental calcium intake prior to surgery for Graves’ disease to help avoid symptoms of hypocalcemia after surgery.”

Guidelines Include 124 Evidence-Based Recommendations  

The updated guidelines present 124 evidence-based recommendations to aid clinicians in the best care of patients with thyrotoxicosis. Critical topics with notable advances in practice include:

Evidence-Based Methodology                                                        

To update the 2011 guidelines, the ATA assembled a task force of 11 experts, representing the fields of adult and pediatric endocrinology, nuclear medicine, and surgery. These task force members systematically examined the relevant literature published over the past 5 years, and incorporated the new knowledge coupled with experience into the new guidelines. The task force’s objective was to outline what they believed to be current, rational, and optimal medical practice without sacrificing the importance of clinical judgment, individual decision-making, and the wishes of the patient or the patient’s family.

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American Thyroid Association Guideline for Treatment of Hypothyroidism