Hypothyroidism is a common and easily treatable condition encountered in primary care. The most common cause of hypothyroidism worldwide is iodine deficiency, particularly in developing nations; in the US, it is chronic autoimmune (Hashimoto’s) thyroiditis. Hypothyroidism is 5 to 10 times more common in women and is often associated with other autoimmune disorders (type I diabetes, Addison’s disease, lupus). In many cases it is iatrogenic, caused by radioactive iodine therapy or surgery for hyperthyroidism or thyroid cancer, or drugs such as lithium, amiodarone, interferon alpha, or tyrosine kinase inhibitors. The American Thyroid Association (ATA), in conjunction with the American Association of Clinical Endocrinologists (AACE), offers a useful practice guideline for managing this prevalent endocrine disorder. Of note, the following summary applies to primary hypothyroidism and does not address management of central hypothyroidism or hypothyroidism in pregnancy, which are considered separate topics.
Controversial—Recommendations Vary by Organization
Check serum TSH and free T4
When to measure Thyroid peroxidase antibody test (TPOAb)
Normalization of a variety of clinical and metabolic endpoints including resting heart rate, serum cholesterol, anxiety level, sleep pattern, and menstrual cycle abnormalities…are further confirmatory findings that patients have been restored to a euthyroid state
Do Not Use Thyroid Hormone to Treat
Adrenal Insufficiency
Interruptions in Treatment
Patients taking Biotin
Factors that Alter Thyroxine and Triiodothyronine Binding in Serum
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