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<p>A blood test measuring hormone levels is the only accurate way to find out if there
is a thyroid problem.</p><br /><p>Best practice on the identification and management
of hypothyroidism has been set out by the Royal College of Physicians (RCP) in its
guidance, <em>The Diagnosis and Management of Primary Hypothyroidism</em>, first published
in 2008. The guidance, which is attached, was developed on behalf of key organisations,
including the British Thyroid Association (BTA), the British Thyroid Foundation (BTF)
and the Society for Endocrinology (SOE), and is endorsed by the Royal College of General
Practitioners. A copy of the UK Guidelines is attached.</p><br /><p>The RCP guidance
sets out that the only validated method of testing thyroid function is through a blood
sample, which must include measurement of the levels of thyroid‐stimulating hormone
(TSH) and free thyroxine (FT4) in serum, as recommended in the <em>UK Guidelines for
the Use of Thyroid Function Tests</em> published by the BTA.</p><br /><p>The RCP guidelines
set out that overwhelming evidence supports the use of thyroxine hormone replacement
(T4 or tetra-iodothyronine) alone in the treatment of hypothyroidism, with this usually
being prescribed as levothyroxine. However, this does not prevent clinicians considering
other forms of thyroid hormone replacement if appropriate.</p><p>The guidance remains
up-to-date and a statement from the BTA Executive Committee supporting the existing
guidelines was published in May 2015 in <em>Clinical Endocrinology</em> and endorsed
by the Association for Clinical Biochemistry and Laboratory Medicine, the BTF, the
RCP and the SOE. The full statement is attached and available online at:</p><br /><p><a
href="http://onlinelibrary.wiley.com/doi/10.1111/cen.12824/full" target="_blank">http://onlinelibrary.wiley.com/doi/10.1111/cen.12824/full</a></p><br
/><p>Regarding international guidance and harmonisation on approaches to testing,
the existing United Kingdom guidelines have now been supported by new guidance published
in the United States of America which draws on the latest research and available evidence
on the management of the condition. The USA guidance also includes a section on the
ethics of prescribing thyroid hormone combination therapies when the potential long-term
harmful effects are not known.</p>
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