Internal Medicine Review: Approach to Hypothyroidism - OHSU

[Pages:20]OHSU Internal Medicine Review: Approach to Hypothyroidism

Chaim Vanek MD (vanekc@ohsu.edu) OHSU Associate Professor, Endocrine

April 15th, 2022

When to check a TSH?

? For any patient complaint

OHSU

Background

? Review my approach

OHSU ? Nosetguidelines

? TSH stands for Thyroid Stimulating Hormone

? Secreted by pituitary gland

? Key lab value to assess thyroid function

? Hypo and Hyper

TSH level: 0.40 to 2.50 uIU/mL

? 100% normal for all age groups and genders

OHSU ? Symptoms are not from the thyroid

TSH level: 2.5 to 5.0 uIU/mL

? Check thyroid antibody (TPO; Thyroid Peroxidase Antibody)

OHSU ? Thyroglobulin antibody less useful

TSH level: 2.5 to 5.0 uIU/mL TPO Ab: Negative

? Unlikely to have clinical hypothyroidism as cause of symptoms

OHSU ? A normal Free T4 also supports normal thyroid function

? If patient insists on therapy:

? Levothyroxine 25 mcg daily for 3 months to gauge symptoms improvement and reduction of TSH to less than 2.5 uIU/mL

? If patient happy with clinical outcome then continue but make patient 100% aware that once on thyroid, always on thyroid

? Lifelong commitment

TSH level: 2.5 to 5.0 uIU/mL TPO Ab: Positive

? Women of child bearing potential

OHSU ? Consider Levothyroxine 25-50 mcg to keep TSH under 2.5 uIU/mL ? Will possibly improve future fertility ? 1st trimester TSH goal is less than 2.5 uIU/mL ? So at goal at the time of pregnancy

? Men under 60 / Women of non child bearing potential or less than 60

? Monitor every 6 months for rise in TSH or ? Trial of Levothyroxine as on prior slide or ? Start Selenium 200 mcg supplementation daily

? Mixed evidence that it supports thyroid function

? Lowers TPO antibodies

OHSU Thyroid Journal

2010

I use it alone, not with Levothyroxine

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