Thyroid disease assessment and management: summary of NICE guidance

### What you need to know Thyroid disease, comprising thyroid dysfunction and enlargement, is common and often identified in primary care. Conditions causing thyroid dysfunction can be broadly divided into those that result in thyroid gland underactivity (overt and subclinical hypothyroidism) or overactivity (thyrotoxicosis). Hypothyroidism is usually managed by general practitioners. This article summarises some of the most recent recommendations from the NICE guideline “Thyroid disease: assessment and management.”1 NICE recommendations are based on systematic reviews of best available clinical evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Committee’s experience and opinion of what constitutes good practice. The levels of evidence supporting the recommendations is given in italics in square brackets. The type of evidence underpinning the recommendations in the guideline varied. Most recommendations were based on randomised controlled trials (RCTs) and Guideline Committee consensus. Conducting RCTs can be challenging in some aspects of thyroid disease management, with ethical and practical challenges of …