HYPOTHYROIDISM-MANAGEMENT
SUMMARY
1. Levothyroxine (T4) alone. T3 is not given: short half-life, unreliable levels, more side-effects.
2. T4 has a long half-life and takes weeks to equilibrate, recheck TSH at 6-8 weeks. Start at 50-100 mcg/day.
4. Track TSH: keep the level within the lower half of the normal reference range.
5. Don't overtreat: risk inciting complications, such as AF & OP.
6. Drugs/conditions that interfere with absorption, raise TBG levels, or increase T4 metabolism: estrogen supplements, iron/calcium/aluminium supplements, cholestyramine, resin binders, malabsorption syndrome.
7. Hypothyroidism does not contraindicate surgery.
8. Follow hypothyroid pregnant patients closely: may require 50% over the pre-pregnancy thyroxine dose. Hypothyroidism during pregnancy adversely affects the baby.
Reference(s)
Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].
