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HYPOTHYROIDISM MANAGEMENT

Endocrinology

HYPOTHYROIDISM MANAGEMENT

1. Levothyroxine (T4) alone.
2. T3 is usually not given - short half-life, wild swings in levels, more side-effects.
3. T4 has a long half-life and takes weeks to equilibrate, recheck TSH at 6-8 weeks.
4. Track TSH - aim < 1/2 of lab value range.
5. Don't over-treat, risk of complications (AF, osteoporosis) high.
6. Drug interactions - 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% increase in thyroxine level. Hypothyroidism during pregnancy adversely affects the baby.


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REFERENCES

1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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