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After noting shortcomings in the care of thyroid patients, the High Authority for Health (HAS), sets out new recommendations. An initiative hailed by Dr. Alina Radu, endocrinologist and diabetologist at the Pompidou Hospital in Paris.
In its press release, the HAS recognizes first that thyroid pathologies, frequent in France – they indeed concern 2% of the population – are not always correctly taken care of. “Even today, their care and follow-up are not always optimal” underlines the health authority.
Thyroid pathology: new recommendations
To remedy this situation, the HAS publishes new comprehensive recommendations for “improve support” sick people.
In its document, the HAS thus recommends adapting the management of hypothyroidism according to the patient. The procedure to follow is detailed in the document: prescription by the attending physician alone, to obtain a dosage of thyroid stimulating hormone or TSH, the abnormal level of which will indicate the presence of a pathology. Once the biological assessment has been made, treatment with levothyroxine will be initiated.
HAS reminds that imaging examinations are not useful and that follow-up can be carried out by the attending physician, except in special cases, such as a patient whose hormone levels are unbalanced or a woman, presenting with pregnancy or desire for children, for example.
The special cases of the elderly and pregnant women
The HAS recommendations also refer to two special cases of patients: people over the age of 65 and pregnant women. In the first case, the HAS recalls that age alone is not a sufficient criterion for looking for a thyroid pathology. In contrast, she notes,this is recommended in certain situations: if clinical signs suggestive of hypothyroidism, when a recent cognitive decline is discovered, if known neurocognitive disorders worsen in an unexplained manner or in the event of treatment with amiodarone” treatment for heart rhythm disorders.
In the case of pregnant women with known hypothyroidism, the doses of levothyroxine must be increased by 20 to 30% in order to meet the needs related to pregnancy. “SIf the pregnant woman does not have access to a doctor or a prescription quickly, she increases her treatment by two more daily doses per week, i.e. 9 tablets instead of 7. After childbirth, the dose should be reduced again. dose of levothyroxine and to measure TSH six weeks later” further indicates the health authority. Finally, “in women at increased risk of developing hypothyroidism, experiencing childbearing difficulties or still undergoing assisted reproduction, HAS recommends measuring TSH during the preconception period or at the start of pregnancy“.
In the case of hyperthyroidism
For patients affected by hyperthyroidism, the HAS recalls that imaging or treatment are not systematic. On the other hand, it is necessary to look for other symptoms in the patient, such as palpitations, nervousness and irritability. Finally, the HAS recalls that surgery consisting in removing the thyroid in the event of hyperthyroidism should only be performed as a last resort and only in the presence of a large goiter or a suspicion of its malignancy.
The opinion of Dr Alina Radu, endocrinologist and diabetologist at the Georges-Pompidou hospital
“In diseases related to the thyroid, doctors often go overboard because there was a lack of clarity around the management of these complex diseases. The recommendations issued are completely relevant, they present decision trees that indicate the way forward. This can help general practitioners to make the right decisions according to the pathology or the patient’s symptoms, it also evokes the particular cases of the elderly person or the pregnant woman… It’s really very clear and well explained, I can only welcome this type of initiative“.