ATA Guidelines Tools

9 29. If surgery is chosen as the primary therapy for GD, the patient should be referred to a high-volume thyroid surgeon. (S-M) 30. Following thyroidectomy for GD, alternative strategies may be undertaken for management of calcium levels: serum calcium ± intact parathyroid hormone levels can be measured, and oral calcium and calcitriol supplementation administered based on these results, or prophylactic calcium with or without calcitriol prescribed empirically. (W-L) 31. ATD should be stopped at the time of thyroidectomy for GD, and β-adrenergic blockers should be weaned following surgery. (S-L) 32. Following thyroidectomy for GD, L-thyroxine should be started at a daily dose appropriate for the patient's weight (0.8 µg/lb or 1.6 µg/kg), with elderly patients needing somewhat less, and serum TSH measured 6–8 weeks postoperatively. (S-L) 33. Communication among different members of the multidisciplinary team is essential, particularly during transitions of care in the pre- and postoperative settings. (S-L) Thyroid Nodules in GD 34. If a thyroid nodule is discovered in a patient with GD, the nodule should be evaluated and managed according to recently published guidelines regarding thyroid nodules in euthyroid individuals. (S-M) Thyroid Storm 35. The diagnosis of thyroid storm should be made clinically in a severely thyrotoxic patient with evidence of systemic decompensation. Adjunctive use of a sensitive diagnostic system should be considered. (S-M) • Patients with a Burch-Wartofsky Point Scale (BWPS) of ≥45 or Japanese Thyroid Association categories of TS1 or TS2 with evidence of systemic decompensation require aggressive therapy. • The decision to use aggressive therapy in patients with a BWPS of 25-44 should be based on clinical judgment. 36. A multimodality treatment approach to patients with thyroid storm should be used, including β-adrenergic blockade, antithyroid drug therapy, inorganic iodide, corticosteroid therapy, cooling with acetaminophen and cooling blankets, volume resuscitation, nutritional support, respiratory care and monitoring in an intensive care unit, as appropriate for an individual patient. (S-L)

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