RESUMO
Background: In 2013, the American Thyroid Association (ATA) issued a "Policy Statement on Thyroid Shielding During Diagnostic Medical and Dental Radiology." The recently updated National Council on Radiation Protection and Measurement Radiation Protection in Dentistry and Oral and Maxillofacial Imaging (NCRP Report No. 177) prompts this review of progress related to patient thyroid shielding since the ATA statement was published. Summary: Relevant publications appearing since the ATA statement were identified by querying PubMed for "thyroid and dental and (collar or shielding)" and substituting specific dental radiographic procedures in the search. The search was expanded by reviewing the cited papers in the PubMed-retrieved papers and by use of the Web of Science to retrieve papers citing the PubMed retrieved publications. Although many quantitative studies have appeared reflective of current dental radiographic instrumentation and practice, much more can be done to foster minimizing radiation to the thyroid. Conclusions: We list seven areas that should be pursued. Among them are harmonizing guidelines for the use of thyroid collars based on the recent studies and a comprehensive survey of current dental radiological practice patterns.
Assuntos
Equipamentos de Proteção , Exposição à Radiação/efeitos adversos , Exposição à Radiação/prevenção & controle , Lesões por Radiação/prevenção & controle , Proteção Radiológica/instrumentação , Radiografia Dentária/efeitos adversos , Glândula Tireoide/efeitos da radiação , Desenho de Equipamento , Humanos , Chumbo , Guias de Prática Clínica como Assunto , Equipamentos de Proteção/normas , Doses de Radiação , Lesões por Radiação/etiologia , Proteção Radiológica/normas , Radiografia Dentária/normas , Medição de Risco , Fatores de RiscoRESUMO
These clinical practice guidelines summarize the recommendations of the American Association of Clinical Endocrinologists for the diagnostic evaluation of hyperthyroidism and hypothyroidism and for treatment strategies in patients with these disorders. The sensitive thyroid-stimulating hormone (TSH or thyrotropin) assay has become the single best screening test for hyperthyroidism and hypothyroidism, and in most outpatient clinical situations, the serum TSH is the most sensitive test for detecting mild thyroid hormone excess or deficiency. Therapeutic options for patients with Graves' disease include thyroidectomy (rarely used now in the United States), antithyroid drugs (frequently associated with relapses), and radioactive iodine (currently the treatment of choice). In clinical hypothyroidism, the standard treatment is levothyroxine replacement, which must be tailored to the individual patient. Awareness of subclinical thyroid disease, which often remains undiagnosed, is emphasized, as is a system of care that incorporates regular follow-up surveillance by one physician as well as education and involvement of the patient.
Assuntos
Hipertireoidismo/diagnóstico , Hipertireoidismo/terapia , Hipotireoidismo/diagnóstico , Hipotireoidismo/terapia , Amiodarona/efeitos adversos , Antitireóideos/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Hipotireoidismo/complicações , Radioisótopos do Iodo/uso terapêutico , Gravidez , Complicações na Gravidez , Hormônios Tireóideos/sangue , Hormônios Tireóideos/uso terapêutico , TireoidectomiaRESUMO
These clinical practice guidelines summarize the recommendations of the American Association of Clinical Endocrinologists for the diagnostic evaluation of hyperthyroidism and hypothyroidism and for treatment strategies in patients with these disorders. The sensitive thyroid-stimulating hormone (TSH or thyrotropin) assay has become the single best screening test for hyperthyroidism and hypothyroidism, and in most outpatient clinical situations, the serum TSH is the most sensitive test for detecting mild thyroid hormone excess or deficiency. Therapeutic options for patients with Graves' disease include thyroidectomy (rarely used now in the United States), antithyroid drugs (frequently associated with relapses), and radioactive iodine (currently the treatment of choice). In clinical hypothyroidism, the standard treatment is levothyroxine replacement, which must be tailored to the individual patient. Awareness of subclinical thyroid disease, which often remains undiagnosed, is emphasized, as is a system of care that incorporates regular follow-up surveillance by one physician as well as education and involvement of the patient.