BMJ Best Practice Podcast Hypothyroidism
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Feb 24, 2025 In this engaging discussion, Dr. Wail Malaty, a family physician from Houston and an expert author on hypothyroidism, sheds light on the condition's prevalence and its far-reaching effects. He emphasizes the critical importance of accurate diagnosis through TSH and free T4 tests. The conversation delves into effective management strategies, including personalized levothyroxine dosing and the nuances surrounding persistent symptoms despite normal TSH levels. Dr. Malaty also addresses the challenges faced in treating subclinical hypothyroidism and pregnant patients.
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Defining Hypothyroidism
- Hypothyroidism is defined as inadequate thyroid hormone production by the thyroid gland.
- 95% of cases stem from gland failure, while 5% result from central issues affecting stimuli.
Diagnosing Hypothyroidism
- Suspect hypothyroidism if patients show fatigue, cold intolerance, weight gain, constipation, or menstrual irregularity.
- Diagnose with lab tests: elevated TSH and low free T4 confirm primary hypothyroidism.
Additional Testing
- Further tests like anti-thyroid peroxidase antibodies are rarely needed for primary hypothyroidism diagnosis in iodine-sufficient areas.
- These tests may be relevant for subclinical hypothyroidism or pregnancy.