Colombian consensus for the diagnosis, treatment and follow-up of hypothyroidism in the adult population
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Thyroid Function Tests
Primary Health Care
Secondary Care

How to Cite

Vargas-Uricoechea, . H., Builes-Barrera, C. ., Arenas-Quintero, H. ., Castellanos-Pinedo, A. ., Restrepo-Erazo, K. ., Duque-Ossman, J. J. ., Rojas-Melo, L. ., Barraza-Gerardino, M. ., Mejía, G. ., Hernández-Triana, E. ., Vásquez-Awad, D. ., Tovar-Cortés, H. ., & Guerra-Rodríguez, N. (2023). Colombian consensus for the diagnosis, treatment and follow-up of hypothyroidism in the adult population. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 10(4).


Background: Hypothyroidism is defined as a syndrome characterized by multiple systemic manifestations, where any of the components of the hypothalamic-pituitary-thyroid axis may be compromised; it is a highly prevalent entity that can affect different populations, regardless of their age group and biological conditions. However, the non-specificity of its symptoms and insidious clinical course generates a challenge in daily clinical practice for the timely and adequate diagnosis, treatment or follow-up of the disease. Regardless of its etiology and classification, currently the treatment of choice is levothyroxine, with the aim of achieving biochemical control. Finally, the follow-up of the patient with hypothyroidism is fundamental to guarantee adequate control, which will allow timely detection of associated comorbidities.

Purpose: Define the criteria for the diagnosis, treatment and follow-up of hypothyroidism in Colombia.

Methodology: A modified Delphi-type consensus was carried out, for which a panel of Colombian endocrinologists, experts in the management of thyroid pathologies, was chosen; Consensus management was performed by a clinical pharmacologist.

The results were analyzed and discussed and, based on the achievement of consensus, the conclusions of the recommendations in the different aspects related to hypothyroidism were summarized.

Results: Recommendations for the approach to patients with hypothyroidism in Colombia were obtained, including clinical suspicion, diagnosis, treatment, and follow-up of the patient with the disease, as well as considerations in special populations from the perspective of the national health system.

Conclusions: In Colombia, it is important to reduce variability in daily clinical practice, as well as to strengthen the knowledge of medical staff, from the primary care setting to highly complex care, regarding the diagnosis, treatment and follow-up of patients with hypothyroidism, in order to provide timely and appropriate management of the disease.
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Campi I, Dell’Acqua M, Stellaria Grassi E, Cristina Vigone M, Persani L. Unusual causes of hyperthyrotropinemia and differential diagnosis of primary hypothyroidism: a revised diagnostic flowchart. Eur Thyroid J. 2023 abr. 17;12(4):e230012.

Mariotti S, Beck-Peccoz P. Physiology of the Hypothalamic-Pituitary-Thyroid Axis. En: Feingold KR, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, et al., editores. Endotext. South Dartmouth (MA):, Inc.; 2000.

Vargas Uricoechea H, Murillo Palacios J, Ramírez Bejarano LE. Análisis del estado poblacional del yodo en Colombia y la necesidad de modificar los niveles de yodación universal de la sal. Rev Colomb Endocrinol Diabet Metab. 2020;7(2):87-98

Taylor PN, Albrecht D, Scholz A, Gutierrez-Buey G, Lazarus JH, Dayan CM, et al. Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol. 2018 my.;14(5):301-16.

Vargas-Uricoechea H. Epidemiología del hipotiroidismo en Colombia ¿en qué estamos y qué sabemos al respecto? Rev Colomb Endocrinol Diabetes Metab. 2020;7(4):274-6.

Vargas-Uricoechea H, Pinzón-Fernández MV, Bastidas-Sánchez BE, Jojoa-Tobar E, Ramírez-Bejarano LE, Murillo-Palacios J. Iodine Status in the Colombian Population and the Impact of Universal Salt Iodization: A Double-Edged Sword? J Nutr Metab. 2019 abr. 1;2019:1-10.

Builes C, Rosero O, García J. Evaluación de disfunción tiroidea según TSH en una población de Bogotá. Acta Med Colomb. 2006;31(2):66-70.

Guideline Central [Internet]. Estados Unidos: American Association of Clinical Endocrinologist, American Thyroid Association. Hypothyroidism in Adults [citado 2023 abr. 26]. Disponible en:

Tsakiridis I, Giouleka S, Kourtis A, Mamopoulos A, Athanasiadis A, Dagklis T. Thyroid Disease in Pregnancy: A Descriptive Review of Guidelines. Obstet Gynecol Surv. 2022 en.;77(1):45-62.

NICE: National Institute for Health and Care Excellence [Internet]. Reino Unido: NICE. Thyroid Disease: Assesssment and Manegement NICE Guideline [NG145] 2019 [CITADO 2023 my. 1]. Disponible en:

Vargas-Uricoechea H, Agredo-Delgado V, Vargas-Sierra HD, Pinzón-Fernández MV. Prevalence of Functional Alterations and the Effects of ThyroidAutoimmunity on the Levels of TSH in an Urban Population of Colombia:A Population-Based Study. Endocr Metab Immune Disord - Drug Targets. 2023 my.;23(6):857-66.

García Valdés M, Suárez Marín M. El método Delphi para la consulta a expertos en la investigación científica. Rev Cuba Salud Pública. 2013;39(2):253-67.

Joint Commission International [Internet]. Estados Unidos: JCI. Accreditation standards for Hospitals; 2021 [citado 2023 mayo 25]. Disponible en:

Matas A. Diseño del formato de escalas tipo Likert: un estado de la cuestión. Redie Rev Electrónica Investig Educ. 2018;20(1):38-47.

Patrão Neves M. Consensus. En: Ten Have H, editor. Encyclopedia of Global Bioethics [Internet]. Cham: Springer International Publishing; 2015 [citado 2023 sept. 25]. p. 1-9. Disponible en:

OCEBM Levels of Evidence Working Group [Internet]. Reino Unido: Oxford Centre for Evidence-Based Medicine. “The Oxford Levels of Evidence 2”; 2011 [2023 mayo 25]. Disponible en:

Chiovato L, Magri F, Carlé A. Hypothyroidism in Context: Where We’ve Been and Where We’re Going. Adv Ther. 2019 sept.;36(S2):47-58.

Chaker L, Razvi S, Bensenor IM, Azizi F, Pearce EN, Peeters RP. Hypothyroidism. Nat Rev Dis Primer. 2022 my. 19;8(1):30.

Canaris GJ, Steiner JF, Ridgway EC. Do traditional symptoms of hypothyroidism correlate with biochemical disease? J Gen Intern Med. 1997 sept.;12(9):544-50.

Reyes Domingo F, Avey MT, Doull M. Screening for thyroid dysfunction and treatment of screen-detected thyroid dysfunction in asymptomatic, community-dwelling adults: a systematic review. Syst Rev. 2019 dic.;8(1):260.

Azizi F. Early Detection and Optimized Management of Thyroid Disease in Pregnancy. Int J Endocrinol Metab. 2014 dic. 16;13(1).

Urgatz B, Razvi S. Subclinical hypothyroidism, outcomes and management guidelines: a narrative review and update of recent literature. Curr Med Res Opin. 2023 mzo. 4;39(3):351-65.

Patil N, Rehman A, Jialal I. Hypothyroidism. Treasure Island (FL): StatPearls Publishing; 2023.

Jansen HI, Boelen A, Heijboer AC, Bruinstroop E, Fliers E. Hypothyroidism: The difficulty in attributing symptoms to their underlying cause. Front Endocrinol. 2023 febr. 6;14:1130661.

Ross DS. Treating hypothyroidism is not always easy: When to treat subclinical hypothyroidism, TSH goals in the elderly, and alternatives to levothyroxine monotherapy. J Intern Med. 2022 febr.;291(2):128-40.

Soh SB, Aw TC. Laboratory Testing in Thyroid Conditions - Pitfalls and Clinical Utility. Ann Lab Med. 2019 en. 28;39(1):3-14.

Ashraff S, Razvi S. Diagnosis and Treatment of Hypothyroidism. En: Vitti P, Hegedüs L, editores. Thyroid Diseases: Pathogenesis, Diagnosis, and Treatment [Internet]. Cham: Springer International Publishing; 2018. p. 391-426. Disponible en:

Ross DS. Laboratory assessment of thyroid function. UpToDate. 2023.

Builes-Barrera CA, Márquez-Fernández JM, Gómez-Baena RM, Cárdenas-Gómez ML. Valores de pruebas tiroideas (TSH y T4 libre) en una población adulta de la ciudad de Medellín, Colombia. Rev Colomb Endocrinol Diabetes Metab. 2017;2(4):20-4.

Alsifri S, Aljuhani N, Aljedai A, Nasser T, Alsabaan F, Almudaiheem H, et al. Clinical Practice Recommendations for Assessment and Management of Hypothyroidism. Int J Clin Med. 2022;13(12):650-78.

Richman DM, Frates MC. Ultrasound of the Normal Thyroid with Technical Pearls and Pitfalls. Radiol Clin North Am. 2020 nov.;58(6):1033-9.

Caron P, Grunenwald S, Persani L, Borson-Chazot F, Leroy R, Duntas L. Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults. Rev Endocr Metab Disord. 2022;23(3):463-83.

Lipp HP. Administration and Pharmacokinetics of Levothyroxine. En: Kahaly GJ, editor. 70 Years of Levothyroxine [Internet]. Cham: Springer International Publishing; 2021 [citado 2023 abr. 20]. p. 13-22. Disponible en:

Okosieme O, Gilbert J, Abraham P, Boelaert K, Dayan C, Gurnell M, et al. Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee. Clin Endocrinol (Oxf). 2016 jun.;84(6):799-808.

Duntas LH, Jonklaas J. Levothyroxine Dose Adjustment to Optimise Therapy Throughout a Patient’s Lifetime. Adv Ther. 2019 sept.;36(S2):30-46.

Esfandiari NH, Papaleontiou M. Biochemical Testing in Thyroid Disorders. Endocrinol Metab Clin North Am. 2017;46(3):631-48.

Donnay Candil S, Balsa Barro JA, Álvarez Hernández J, Crespo Palomo C, Pérez-Alcántara F, Polanco Sánchez C. Cost-effectiveness analysis of universal screening for thyroid disease in pregnant women in Spain. Endocrinol Nutr Engl Ed. 2015;62(7):322-30.

Hypothyroidism in adults. Levothyroxine if warranted by clinical and laboratory findings, not for simple TSH elevation. Prescrire Int. 2015;24(164):241-6.

Vargas J, Molina G. Acceso a los servicios de salud en seis ciudades de Colombia: limitaciones y consecuencias. Rev Fac Nac Salud Pública. 2009;27(2):121-30.

El Awad AM, El Gaili DE, Habor AB, Ahmed AM. Hypothyroidism. The need for high degree of suspicion for early diagnosis. Saudi Med J. 2001;22(1):76-7.

Schiff GD. Missed Hypothyroidism Diagnosis Uncovered by Linking Laboratory and Pharmacy Data. Arch Intern Med. 2005;165(5):574.

Keestra S, Högqvist Tabor V, Alvergne A. Reinterpreting patterns of variation in human thyroid function. Evol Med Public Health. 2021 febr. 26;9(1):93-112.

Abuhadba-Cayao KA, Talavera JE, Vera-Ponce VJ, Cruz-Vargas JA. Medical treatment in pregnant women with subclinical hypothyroidism: systematic review and meta-analysis. Rev Bras Saúde Materno Infant. 2022;22(2):227-35.

Hegedüs L, Bianco AC, Jonklaas J, Pearce SH, Weetman AP, Perros P. Primary hypothyroidism and quality of life. Nat Rev Endocrinol. 2022;18(4):230-42.

Rizzo LF, Mana DL. Treatment of hypothyroidism in special situations. Medicina (Mex). 2020;80(supl. 6):83-93.

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