Tell me why?
This disease is often the cause of hypothyroidism.
What is Hashimotos disease or lymphocytic thyroiditis.
These medications may interfere with the absorption of T4.
What are PPI's and antacids
Bile acid sequestrants (resins)
Soy supplements
Calcium
Raloxifene
Skin exam in the hypothyroid patient.
What is dry and coarse skin.
High TSH level. Pain. Elevated Sed rate
What is subacute thyroiditis.
Your patient feels well has a normal exam but labs are TSH 8, T4 normal.
What is subclinical hypothyroidism.
Amiodarone and lithium affect the uptake of this element.
What is iodine.
These two types of medicines may increase the metabolism of levothyroxine.
What are anti seizure meds
What are anti TB meds.
The eyes may tell the story in hypothyroidism.
What are puffy eyelids
This condition may demonstrate Low or normal TSH. Low T4. Normal brain MRI.
What is Traumatic brain injury.
You feel the thyroid gland is enlarged and ultrasound demonstrates multiple nodules.
What is a multinodular goiter.
You should screen for thyroid disease in these 3 conditions.
What are Type I Diabetes.
Morbid obesity
Patients who come from endemic areas with low Iodine intake.
Pregnant women 30 years old or older with preterm delivery, 2 or more pregnancies.
Infertility
These drugs increase serum T4 binding proteins.
What are estrogens.
You may have to check these twice because they are so slow.
What are delayed reflexes in hypothyroid patients.
Low or normal TSH. Low T4. Headaches and visual field cuts.
What is a pituitary or hypothalamic tumor.
Your patient is 80 years old has HFrEF of 35% and has TSH of 25 with low T4. You decide to start treatment with this dose...
What is 0.025 mg. ( 25 MCG.) of Levothyroxine and titrate every 6-8 weeks.
The rate of progression from subclinical hypothyroidism to clinical is 2-3 times faster in this group of patients.
Patients with anti TPO antibodies.
These drugs inhibit T4 to T3 conversion
What are :
Lithium
Propanolol
Amiodarone
Glucocorticoids
Sometimes you can spot this across the room.
What is a goiter.
This TSH level may be seen in patients taking amiodarone or lithium.
What is elevated TSH ( also seen in iodine, interferon, kinase and checkpoint inhibitors).
Use this weight when calculating a weight based dose for healthy hypothyroid patients.
What is lean body weight or mass.
Male LBM = (0.32810 x W in kg.) + 90.33929 x H in cm.0 - 29.356
Female LBM = (0.29569 x W in kg.) + (0.41813 x H in cm.) - 43.2933
Treatment of these patients with T4 until there TSH was normal did not relieve their hypothyroid symptoms.
What are patients with polymorphism to Thr 92 ALA. ( These patients may benefit from T4/T3 combination meds).
These drugs decrease TSH secretion.
What are dopamine and glucocorticoids
Octreotide
Mitotane
Metformin
Bexarotene
Swelling may occur in these in patients with hypothroidism.
What are muscles.
In these two conditions the TSH and FT4 are both low.
Post surgery to the pituitary.
Post Radiation of the pituitary or hypothalmus.
The average T4 dose for otherwise healthy adult is this dose.
What is T4 1.6 mcg/kg. of body wt./day.