{"id":1471,"date":"2017-07-19T13:53:03","date_gmt":"2017-07-19T13:53:03","guid":{"rendered":"http:\/\/papergp.com\/index.php\/data-interpretation\/tfts\/"},"modified":"2023-01-24T11:25:25","modified_gmt":"2023-01-24T11:25:25","slug":"tfts","status":"publish","type":"page","link":"https:\/\/papergp.com\/index.php\/data-interpretation\/tfts\/","title":{"rendered":"TFTs"},"content":{"rendered":"<div class=\"content-box-blue\">\n<h4><strong>Hypothyroidism<\/strong><\/h4>\n<ul>\n<li>Overt primary hypothyroidism (T4 low, TSH raised &gt; 10)\n<ul>\n<li>Start levothyroxine (if transient thyroiditis is excluded)<\/li>\n<\/ul>\n<\/li>\n<li>Subclinical primary hypothyroidism (T4 normal, TSH raised)\n<ul>\n<li>Many cases are transient<\/li>\n<li>TSH &lt; 10\n<ul>\n<li>repeat after 3 months to see if changes are persistent\/progressive<\/li>\n<li>request anti-TPO antibodies to determine if autoimmune process and help predict risk of progression to overt hypothyroidism<\/li>\n<li>On repeat test\n<ul>\n<li>TSH &gt; 10 mU\/L\n<ul>\n<li>start levothyroxine<\/li>\n<\/ul>\n<\/li>\n<li>TSH 4.5 &#8211; 10 mU\/L\n<ul>\n<li>annual monitoring<\/li>\n<li>a trial of T4 can be considered if symptomatic with goitre or planning pregnancy or anti-TPO positive<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Levothyroxine (T4 replacement)\n<ul>\n<li>Initiation\n<ul>\n<li>start at 50 mcg OD then increase in 25mcg increments\n<ul>\n<li>monitor TFTs after 8 weeks and titrate accordingly<\/li>\n<\/ul>\n<\/li>\n<li>if older or IHD, consider starting at 25mcg OD<\/li>\n<li>Aim for TSH and free T4 within normal range and patient to feel well<\/li>\n<\/ul>\n<\/li>\n<li>When to refer\n<ul>\n<li>TSH not in normal range despite Levothyroxine 200mcg OD<\/li>\n<li>Symptoms despite adequate TFTs<\/li>\n<li>&lt; 16 years old<\/li>\n<li>Pregnant or postpartum<\/li>\n<li>Nodular goitre<\/li>\n<\/ul>\n<\/li>\n<li>Interactions\n<ul>\n<li>OTC medications that impair T4 absorption &#8211; PPIs, H2 antagonists, calcium carbonate, ferrous sulphate, soy protein, aluminium hydroxide<\/li>\n<li>Higher T4 requirement may be required in patients who are pregnant, on anticonvulsants or oestrogen containing oral contraceptives<\/li>\n<li>Do not take T4 within 4 hours of taking other medications<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>T3 replacement\n<ul>\n<li>Rarely required, no consistent evidence of its use combined with T4<\/li>\n<li>Aim of T3 therapy is to normalise TSH<\/li>\n<li>T3 measurements are of limited value due to variability of T3 concentrations of blood after T3 dose<\/li>\n<li>Measurement of free T4 is of no value in assessing patients on T3<\/li>\n<\/ul>\n<\/li>\n<li>Hypopituitarism\n<ul>\n<li>Diagnosis\n<ul>\n<li>Secondary hypothyroidism should be considered in patients present with low T4 and low\/normal\/slightly raised TSH<\/li>\n<li>However most low T4, normal TSH is due to non thyroid illness or use of medications such as NSAIDs, furosemide, anti-convulsants or high dose glucocorticoids<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<h4><strong>Hyperthyroidism<\/strong><\/h4>\n<ul>\n<li>Over hyperthyroidism TSH &lt; 0.01 mU\/L, Free T4\/T3 high\n<ul>\n<li>Refer to endocrinology<\/li>\n<\/ul>\n<\/li>\n<li>Subclinical hyperthyroidism TSH &lt; 0.01 mU\/L, Free T4\/T3 normal\n<ul>\n<li>Exclude illness and drugs (dopaminergic drugs, high dose steroids) that suppress TSH<\/li>\n<li>Repeat TSH\/FT4\/T3 1 month later\n<ul>\n<li>If abnormalities persist &#8211; refer to endocrinologist<\/li>\n<li>If improvement, monitor every 6-12 months<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Hypothyroidism Overt primary hypothyroidism (T4 low, TSH raised &gt; 10) Start levothyroxine (if transient thyroiditis is excluded) Subclinical primary hypothyroidism (T4 normal, TSH raised) Many cases are transient TSH &lt; 10 repeat after 3 months to see if changes are persistent\/progressive request anti-TPO antibodies to determine if autoimmune process and help predict risk of progression &hellip; <a href=\"https:\/\/papergp.com\/index.php\/data-interpretation\/tfts\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">TFTs<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":1261,"menu_order":27,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1471","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/1471","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/comments?post=1471"}],"version-history":[{"count":5,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/1471\/revisions"}],"predecessor-version":[{"id":2083,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/1471\/revisions\/2083"}],"up":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/1261"}],"wp:attachment":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/media?parent=1471"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}