Getting thyroid medication right – Your questions answered

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Description

The questions answered in this podcast are listed below. They were compiled by GPs and health professionals around Australia.

  1. Within the investigations, we’re looking at blood tests, and what are we measuring? Are we going to test T3, TSH, T4? What’s the role of reverse T3?
  2. How do you measure iodine and is it worthwhile?
  3. How often should GPs do TSH measurements in patients? Is yearly for patients over 50 years of age too much?
  4. What level of dyslipidemia would you advise commencing levothyroxine? Do you use absolute cardiovascular risk assessment to help with the decision?
  5. Any role for vitamin D in subclinical hypothyroidism?
  6. Why does the thyroid start to fail in the context of subclinical hypothyroidism?
  7. Subclinical hyperthyroidism, is there such an entity? How would you investigate or manage them?
  8. Are there other scenarios where GPs should think about imaging? And if so, what is there to consider?
  9. The measurements of iodine in women who intend to get pregnant, when should we be doing it? How much should we be supplementing?
  10. Do you ever re-check the thyroid function in a woman, especially if they got a long course of IVF?
  11. Can a patient with depression use low dose thyroxin, 25 micrograms per day if the TSH is in the upper limit of normal to improve their mood, if they are already on an antidepressant?
  12. Chronic fatigue syndrome, in whether or not it is advised by specialists and also those who do integrative medicine?
  13. Can you comment on the use of Ozempic in hyper and hypothyroidism?
  14. Amiodarone interpretation of thyroid function tests? If a patient had amiodarone induced hypothyroidism, how do you interpret the thyroid function tests?
  15. Can people with Hashimoto’s ever stop thyroid replacement therapy?
  16. Should thyroxin be stored in the fridge? If so, what are the practical issues involved in managing that?
  17. I have a newly pregnant lady with new onset TSH less than 0.01 and T4 of 24. She’s asymptomatic, she miscarried. Her hCG fell so did her T4. It’s now in the normal range, although the TSH remains less than 0.01, antibodies negative. She’s actively wanting to get pregnant again. Should she have her Eltroxin reduced?

 

Guest: Prof Duncan Topliss AM, Endocrinologist

Host: Dr David Lim, GP and Medical Educator

Total time: 49 mins

 

Last Updated: 28 Nov, 2023

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Prof Duncan Topliss AM

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Prof Duncan Topliss AM

Endocrinologist; Dept of Endocrinology & Diabetes, The Alfred, Melbourne

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