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
Please log in to ObGFirst to access the 2T US Atlas
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
