Hypothyroidism: Replacement therapy Guide

Hypothyroidism: Replacement therapy Guide

Hypothyroidism: Replacement therapy Guide
  1. Resolve symptoms, and return TSH to normal. Grade A
  2. Lthyroxine LT4 is the first choice of treatment for all hypothyroid patients. Grade A
  3. Treatment TSH target range is 1-3  not the reference range of 0.5-5.0. Elderly over-treatment and with cardiac risks should have TSH 3-5. Grade B.
  4. All LT4’s are preferred for starting treatment. Grade B
  5. Patients without a thyroid gland  should have their dose based on the severity of hypothyroidism and other factors.Grade A
  6. Replacement dose can be given routinely when starting therapy. Selected cases based on age cardiac risks can start wit 25 mcgs and progressively increased at 6 week intervals  monitoring TSH without symptoms. Grade A
  7. TSH should be measured at 4-6 weeks of treatment. Grade B
  8. TSH targets and the well being of the patients are the goal. grade D
  9. Factors that effect T4 treatment. Gi disorders, food intake timing, timing of ingestion of the T4. and interfering drugs Grade A
  10. Unstabe TSH levels should be checked for compliance, GI absorption issues, and other drugs. grade B
  11. Liquid T4 may be used for GI absorption issues grade C
  12. Maintain patient on the same T4 they were started on and were tested on if the TSH was stable grade A
  13. If the patient is switched to a different T4 they need a new 6 week TSH  test. grade A
  14. Combo T4/T3 is not recommended due to low quality of evidence. Grade DDDD. It can be tried for a rare few who have normal TSH but still are complain of symptoms
  15. The T4/T3 ratios in animal thyroid extracts such as Armour thyroid should not be used as they cause surges of T3 in the blood. individual T4 and T3  can be used with T4/T3 ratios of 20/1. Add Free T3 to TSH and Free T4 blood tests. grade C
  16. Elderly patient, cardiac, and pregnant  should not take combo T4/T3 products such as Armour  animal thyroid extract. cardiac. Grade B.
  17. T3 or Cytomel should not be used to treat hypothyroidism. It has only use in preparation for radioiodine therapy and in the T3 withdrawal test of Nicoloff to determine if a patient was given thyroid inappropriately to determine if they are normal. Grade A
  18. T4 should never be used in people with normal TSH for obesity, high cholesterol, and other non-specific symptoms. grade A
  19. T3 surges when taking Armour thyroid animal extract is the main reason for avoiding its use in treating hypothyroidism.grade C
  20. Thyroid supplements are not recommended for treatment of hypothyroidism. They can have iodine, sympathomimetic amines like TRIAC. They also those marked thyroid support can be adulterated with actual thyroid hormones.grade C 

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