Management of elevated TSH levels in adult patients in primary care: Introduction of the New Guideline (S2k) of the German college of general practitioners and family physicians (DEGAM)

Background: Laboratory tests of the thyroid-stimulating hormone (TSH) are often requested in medical care and result in physician-patient consultations about "elevated TSH" and the need for further diagnostic and therapeutic decisions. This article presents the new DEGAM guideline "Elevated TSH levels in family medicine" and the discussion of its key recommendations on diagnostics and treatment in patients with elevated TSH levels. Methods: The guideline is based on a literature review of PubMed and the Cochrane database on elevated TSH le-vels/hypothyroidism in the setting of primary care. Using the Delphi method the recommendations were consented. with lected members of the German Societies of Internal Medicine and Endocrinology. Results: An elevated TSH level is defined by > 4.0 mU/l. The recommendations for diagnostics sensitize the user to early detection and medical intervention, and the need for interdisciplinary cooperation in case of complications and potentially dangerous courses. Furthermore, advice for preventing early pathologization in case of asymptomatic slightly altered TSH levels is given. Treatment recommendations point out the requirements and conditions for drug treatment, and also when such a therapy is unnecessary. Conclusions: Elevated TSH levels can be interpreted re further diagnostics and therapy. In particular, the case of latent hypothyroidism creates uncertainties for which the guideline attempts to provide guidance. Critically reflection of diagnostic and therapeutic procedures should help to prevent overdiagnosis. The guideline sensitizes the user to the active involvement of patients in decisionmaking to support highest possible adherence. © Deutscher Ärzteverlag.