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New NICE Guidelines Issued for Thyroid Disease

January 29, 2020

Following an evidence review led by University of Birmingham researchers in the United Kingdom, the National Institute for Health and Care Excellence (NICE) has issued new guidelines for the assessment and management of hyperthyroidism and other thyroid diseases.1

"There has been uncertainty in the [United Kingdom] about the best treatment for hyperthyroidism despite radioactive iodine being the most common first line treatment for this condition in the [United States]. We are very pleased to have been able to work with NICE to provide clear new guidance which we hope will improve outcomes for patients with this condition,” said Kristien Boelaert, MD, PhD, clinical lead on behalf of the guideline committee, in a press release.2

Key recommendations in the new guidance include:1

  • Radioactive iodine is recommended as first-line therapy for the treatment of thyrotoxicosis with hyperthyroidism, unless antithyroid drugs are likely to achieve remission, or it is unsuitable for the patient.
  • Adults under age 65 years with primary hypothyroidism and no history of cardiovascular disease (CVD) are recommended to receive a starting levothyroxine dose of 1.6 μg/kg/day (rounded to the nearest 25 μg).
  • Adults aged 65 years or older and adults with a history of CVD are recommended to receive a starting levothyroxine dose of 25 to 50 μg/day with titration.
  • Natural thyroid extract or liothyronine (alone or in combination with levothyroxine) is not recommended for the treatment of primary hypothyroidism.
  • Clinicians are recommended to aim to maintain thyroid stimulating hormone (TSH) levels within the reference range when treating primary hypothyroidism with levothyroxine. If symptoms persist, clinicians may consider adjusting the dose of levothyroxine further, but should avoid using doses that cause TSH suppression or thyrotoxicosis.

—Christina Vogt


  1. Vasileiou M, Gilbert J, Fishburn S, Boelaert K. Thyroid disease assessment and management: summary of NICE guidance. BMJ. 2020;368:m4
  2. New guidelines will improve treatment for patients with hyperthyroidism [press release]. Birmingham, England, UK. University of Birmingham. January 29, 2020. Accessed January 29, 2020.
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