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Document Overview

Design and created by Guideline Central in participation with the American Association of Clinical Endocrinologists and American Thyroid Association.

Hypothyroidism in Adults

American Association of Clinical Endocrinologists

American Thyroid Association

Publication Date: Dec 1, 2013

Page Last Updated: Feb 5, 2026

AMERICAN PHYSICAL THERAPY ASSOCIATION Grading System

Strength of Recommendation
Grade	Recommendation	Description
A	Strong	A preponderance of level I and/or level II studies supports the recommendation, This must include at least 1 level I study.
B	Moderate	A single high-quality randomized controlled trial or a preponderance of level II evidence supports the recommendation.
C	Weak	A single level II study or a preponderance of level II and TV studies supports the recommendation.
D	Theoretical/foundational	A preponderance of evidence from animal or cadaver studies, from conceptual/theoretical models/principles, from basic science/bench research, or from published expert opinion in peer-reviewed journals supports the recommendation.
P	Best practice	Recommended practice based on current clinical practice norms, exceptional situations where validating studies have not or cannot be performed, and there is a clear benefit, harm or cost, and/or the clinical experience of the guideline development group.
R	Research	There is an absence of research on the topic, or higher-quality studies conducted on the topic disagree with respect to their conclusions. The recommendation is based on these conflicting or absent studies.

Authoring Societies

American Association of Clinical Endocrinologists

Full Text Guideline: www.endocrinepractice.org/article/S1530-891X(20)43030-7/fulltext#secst0005

Source Citation: Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, Pessah-Pollack R, Singer PA, Woeber KA; American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012 Nov-Dec;18(6):988-1028. doi: 10.4158/EP12280.GL. Erratum in: Endocr Pract. 2013 Jan-Feb;19(1):175. PMID: 23246686.

Evidence Quality
Grade	Description
I	Evidence obtained from high-quality (≥50% critical appraisal score) diagnostic studies, prospective studies, or randomized controlled trials
II	Evidence obtained from lesser quality (<50% critical appraisal score) diagnostic studies, prospective studies, or randomized controlled trials
III	Case-controlled studies or retrospective studies
IV	Case study or case series
V	Expert opinion