Specificity of symptoms

The percentage of euthyroid, subclinical hypothyroid, and hypothyroid subjects who reported
no, 1, 2, 3, or 4 or more symptoms

Canaris, G. J. et al. Arch Intern Med 2000;160:526-534.

Copyright restrictions may apply.

 Does it pay to screen for
hypothyroidism?
The percentage of subjects with an elevated thyrotropin (thyroid-stimulating hormone [TSH])
level by sex and decade of age

Canaris, G. J. et al. Arch Intern Med 2000;160:526-534.

Copyright restrictions may apply.

 HYPOTHYROIDISM
• Goals of treatment
– Normalize TSH concentration!
• Most patients feel best when TSH is at the low end of normal
• Pitfalls in treatment
– Hoping that correcting hypothyroidism will resolve all
problems
• DO NOT monitor T-3
• DO NOT monitor thyroid antibody titer
 Hypothyoidism- Investigation
• TSH, Free T4
• Anti-TPO antibodies
• Nuclear scan not indicated
• Ultrasound for asymmetric thyroid
enlargement
• If hypopituitarism suspected:
– TSH not reliable; diagnosis by Free T4 only
– Assess remainder of pituitary function to
support diagnosis
 Hypothyroidism- DDx
• Hashimoto’s thyroiditis
• Post-ablative
• Congenital
• Drug induced
– Lithium
– Amiodarone
– Interferon
• 2⁰