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Main Clinical Subjects

Main Clinical Subjects Sponsored by the JTA

The JTA council has focused on and sponsored three important main clinical subjects in 2004 and 2006 to ensure improvements in patients clinical care and to promote clinical and basic research applications for thyroid diseases. The three main subjects in Japan are (1) the nation-wide search for and establishment of treatment guidelines for patients with subclinical hypothyroidism, (2) the development of guidelines for the radioiodine therapy of Graves disease and (3) the establishment of diagnostic critera for and nation-wide search for the thyroid storm. As chairman, Dr. Amino N. leads the committee for the first subject, the committee for the second subject is headed by Dr. Konishi J, and the third one is headed by Dr. Akamizu T.

The guideline Committee for Subclinical Hypothyroidism

This committee was organized to examine the prevalence of subclinical hypothyroidism in Japan and to establish guidelines for its treatment. The prevalence of subclinical hypothyroidism has been reported to be between 4% and 10% in the general population in Western countries, but few data have been available in Japan. Moreover, management of this condition is controversial. Recent reports suggest the beneficial effects of thyroxine therapy to prevent the progression to overt hypothyroidism and to reduce the future risk of cardiovascular disease. However, no large prospective trial has been undertaken in Japan. Under these circumstances, the Executive Council of the Japan Thyroid Association (JTA) has approved an examination of the prevalence of subclinical hypothyroidism in Japan and the develpment of guidelines for the treatment of subclinical hypothyroidism. In response to this proposal, an official guideline committee was established in November, 2004 and the 22 committee members are now fixed. The chairman is Dr. Nobuyuki Amino. The committee has started to review previous reports and to examine the prevalence of subclinical hypothyroidism in Japan. It is expected that it will take more than 5years to prove the beneficial effects of thyroxine therapy.

The Guideline Committee for the Radioiodine Therapy of Graves Disease

This committee was organized to develop guidelines for the radioiodine treatment of Graves disease during the 47th Annual Meeting of the Japan Thyroid Association, November 11-13, 2004. The committee consists of eleven members, and is headed by Dr. J. Konishi. At the 1st meeting, on November 12, 2004, it was decided to develop guidelines over a period of two years, to promote a wider use of safe and effective radioiodine therapy for Graves disease by general practitioners. The group will review the literature and accumulate evidence on:

1.
Indication of treatment for young patients by setting the lowest age limit, and standardization of the treatment dosage.
2.
Complications such as ophthalmopathy and neonatal Graves disease, and the necessity for concomitant treatment with anti-thyroid drugs (ATD).
3.
Cost-effectiveness.

The Guideline Committee for Thyroid Storm

This committee was organized to develop diagnostic criteria for thyroid storm and to survey the incidence in Japan. Furthermore, we aim to develop guidelines for the treatment of thyroid storm to improve the prognosis. The committee consists of nine members, being headed by Dr. Takashi Akamizu. It started in March, 2006, as two-year term, and is linked to the research activities of both Japan Endocrine Society and the Ministry of Health, Labour and Welfare.

The Guideline Committee for Myxedema Coma

This committee was organized to develop diagnostic criteria and guidelines for its treatment to improve prognosis. The committee consists of 6 members, and is headed by Dr. K. Kasai. At the 1st meeting, on November 15, 2007, it was first decided to develop diagnostic criteria for myxedema coma. This work is linked to the research activities of the Ministry of Health, Labour and Welfare.

The guideline committee for resistance to thyroid hormone (RTH)

The mission of this committee is to establish the diagnostic criteria of RTH for general physicians. This committee was founded in 2008 being composed of 17 members (Chairman:Dr. Masatomo Mori, Vice chairman:Dr. Yoshiharu Murata). Since then, we held 4 meetings during annual meetings of either Japan Endocrine Society or Japan Thyroid Association. First, we discussed how to define RTH. After several communications among the members, we agreed that working definition of RTH is “A syndrome that is caused by reduced sensitivity to T3 due to certain mechanisms and manifests inappropriate secretion of TSH (SITSH)”. We then surveyed RTH cases that the members experienced by identifying mutations in the T3 receptor beta (TRβ) gene. Together with published cases, we found 98 cases from 71 families in Japan. Among them, at least 21 cases had a history of inappropriate treatments with anti-thyroid drugs, surgical thyroidectomy or radioactive iodine. To avoid such inappropriate treatment to RTH, we recognized again the importance to establish the diagnostic criteria and to present a guideline to assist general physicians to make proper diagnosis of RTH.

The Guideline Committee for thyroid nodules

The prevalence of thyroid nodules is very high. Using ultrasonographic examination (US) at the medical checkup, thyroid nodules can be detected about 30% of middle-aged and older people. The frequency of differentiated thyroid cancer especially papillary thyroid cancer (PTC) is increasing and distinction between malignant thyroid tumor from benign nodules is the very important clinical practice. While detection of PTC is not so difficult by US and fine needle aspiration (FNA), making the diagnosis of follicular thyroid cancer before operation is very difficult, since it shows no decisive characteristic findings. This difficulty induces clinical controversy over how to treat thyroid nodules. In order to propose the “best” methods to diagnose and manage thyroid tumors, the JTA has founded the guideline taskforce on thyroid nodules in 2008. The guideline committee (chairman: Dr. Hirotoshi Nakamura) is composed of totally 29 specialists in internal medicine, surgery, pathology, radiology and laboratory medicine. Although selection of the best methods for diagnosis and management of thyroid nodules is not easy due to the lack of high quality evidence obtained from randomized controlled trials, the committee is making an effort to establish the guideline.

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