Diagnostic Tests – Hypothyroidism

by Carlo Raj, MD

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    Let’s diagnose hypothyroidism. Free T4 in all forms. TSH will be increased only in what kind of hypothyroidism? Primary. Anti-thyroglobulin or anti-thyroperoxidase are huge markers so that you can perhaps identify and diagnose a patient with Hashimoto. Hypothalamic and pituitary disease, tell me what these are respectively? You would call hypothalamic hypothyroidism - tertiary; you will call pituitary hypothyroidism - secondary. In both of these instances, you would expect your TSH levels to be decreased. Now, that first bullet point should make perfect sense that no matter what the cause of your hypothyroidism, by definition, you have free T4 in all forms. Hypothyroidism… synthetic thyroxine is treatment of choice, right? In other words, synthroid. Replacement dose typically, well, the dosage is here, you may take a look at it as you wish. Start a full dose in a young patient, however as it get older, you want to be careful as to how much synthroid that you give, please. Typically requires a dose increase when pregnant or taking oestrogen, why? If your patient presenting with hypothyroidism, you’re giving them thyroxine T4; patient pregnant oestrogen increased thyroid binding globulin, it is going to then rob or attach the free T4, therefore the administration of your synthroid that you’ve given initially is pretty much ineffective or has decreased effectiveness, doesn’t it? Increase your dosage, that you want to know. Adjust the T4 of replacement dose… well, here, once again, if you want to take a look at the dosage, you may do so in your own time; adjust those every six to eight weeks because you’re worried about… now, the half-life is important for you to know of approximately one week. You’re monitoring this patient just about as often as you can. Treatment, well, specific situations… subclinical hypothyroidism… controversial, we’ll let it...

    About the Lecture

    The lecture Diagnostic Tests – Hypothyroidism by Carlo Raj, MD is from the course Thyroid Gland Disorders.

    Included Quiz Questions

    1. Tertiary hypothyroidism
    2. Hashimoto's thyroiditis
    3. Silent thyroiditis
    4. Cretinism
    5. Grave's disease
    1. Low TSH
    2. Low free T4
    3. Increased TSH
    4. Anti-TPO antibodies
    5. Anti-thyroglobulin antibodies
    1. Increased estrogen increases TBG, which lowers free T4
    2. Higher levels of T4 are required to cross the placenta
    3. Increased estrogen increases TBG, which increases free T4
    4. Systemic stress of pregnancy exacerbates hypothyroidism
    5. Pregnancy increases likelihood of sensitization to synthetic thyroxin
    1. Secondary hypothyroidism
    2. Hashimoto's thyroiditis
    3. Secondary hyperthyroidism
    4. Myxedema coma
    5. Grave's disease

    Author of lecture Diagnostic Tests – Hypothyroidism

     Carlo Raj, MD

    Carlo Raj, MD

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