Thyroid Pharmacotherapy

Normal Thyroid Physiology

Thyroid stimulation and feedback

Laboratory Tests for Thyroid

Total T4 Free T4 Total T3 TSH
Normal

4.5 – 12.5 mcg/dl

0.8 –  1.5 ng / dl

80 – 220 ng/dl

0.3 – µU /  mL

Hyperthyroid

Hypothyroid

Thyroid Clinical Pearls

  • Normal levothyroxine dose is 1.6 mcg/kg/ day
  • Some people may benefit symptomatically from addition of 50mcg of T3 to levothyroxine
  • Normal TSH should probably not be above 3.5 Treated
  • Untreated TSH should be between 0.5 to 3.8 mU/L
  • 100 and 300 mcg tabs have yellow dye #5 and have allergic potential

Amidarone induced hypothyroidism: 2 mechanisms :

  • Thyroiditis: use a steroid
  • Iodine induced: use Synthroid

Subclinical hyperthyroidism consequences:

  • Osteoporosis mostly in post-menopausal women
  • A. Fib. 3 fold increase in risk
  • Increase LV mass (diastolic dysfunction)

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