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afya
Hypothyroid Mx
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> If sub-clinical and not treated it may revert to normal or stay the same or progress to clinical more likely to progress if high levels of Abs and higher TSH for longer Rx with thyroxine if .... TSH >10, or TSH 4.5-10 with Sx/pregnant/abN lipids/Abs+ve/ovulation dysfunction Aim for TSH 0.5-2.5 Recheck T4 and TSH 3/12thly till stable then yearly (check 6-8/52 post dose change) ''Thyroxine dose'' - start at 50mcg daily (or 25 if elderly / subclinical/ IHD(or severe Sx)) average 100mcg F, 125mcg M Rx - prevents progression to overt plus resolves Sx, mood, cognition and abN lipids Do not let TSH fall below 1 or you get neuropsych Sx, osteoporosis and AF Note .... Rx is lifelong long half life - so takes 2/52 for effect to be felt and maybe 6/12 till Sx fully resolve missing one tab OK but more than that Sx may recur take tabs on empty stomach in UK - gives you free prescriptions adjust dose with 25mcg increments elderly with CVS disease - titrate up slowly beware if pituitary problem - assess adrenals as needs steroids pre thyroxine No evidence that liothyronine with levothyroxine is useful Note - Iron decreases levothyroxine absorption - so give 2 hrs apart ''Side Effects'' Hyperthryoidism reduced bone mineral density worsening angina AF
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Hypothyroid