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From: Rod on 13 Aug 2008 17:58
Somehow I had mamaged to miss this new article in the BMJ. As usual,
only part is available to us non-subscribers. :-(

(It might be necessary to sign up to some free registration scheme to
view this - I am not sure.)

===============

Management of hypothyroidism in adults

Bijay Vaidya, consultant endocrinologist and honorary senior clinical
lecturer, Simon H S Pearce, professor of endocrinology and honorary
consultant physician

Department of Endocrinology, Royal Devon and Exeter Hospital, Exeter EX2
5DW, and Peninsula Medical School, Exeter, 2 Endocrine Unit, Royal
Victoria Infirmary and Newcastle University, Newcastle upon Tyne

Correspondence to: B Vaidya bijay.vaidya(a)pms.ac.uk
The first 150 words of the full text of this article appear below.

Hypothyroidism is one of the commonest chronic disorders in Western
populations. In the United Kingdom, the annual incidence of primary
hypothyroidism in women is 3.5 per 1000 and in men 0.6 per 1000.1 During
2006 12 million prescriptions for levothyroxine (50 µg or 100 µg
tablets) were dispensed in England, equivalent to about 1.6 million
people taking long term thyroid replacement therapy, about 3% of the
population.2 The management of hypothyroidism is generally considered
straightforward and is mostly carried out in primary care in the UK.
Cross sectional surveys of patients taking levothyroxine have, however,
shown that between 40% and 48% are either over-treated or
under-treated.3 4 Furthermore, a small but significant proportion of
patients continue to feel unwell despite taking levothyroxine.5 This
review discusses current approaches in the management of hypothyroidism
in adults.

Summary points

What are the causes of hypothyroidism?

Box 1 Important causes of hypothyroidism
How do patients with hypothyroidism present?

Box 2 Presenting features of hypothyroidism
How to diagnose hypothyroidism?

Whom to treat for hypothyroidism?

Overt hypothyroidism with thyroid stimulating hormone concentrations >10
mU/l
Subclinical (mild) hypothyroidism: thyroid stimulating hormone between 5
and 10 mU/l (free serum thyroxine in reference range)
Patients with symptoms of hypothyroidism but normal thyroid stimulating
hormone levels
How to treat hypothyroidism?

How to monitor levothyroxine replacement
What is the target level for thyroid stimulating hormone?
What are the challenges of levothyroxine replacement?

A persistently abnormal thyroid stimulating hormone level
Box 3 What to tell patients with newly diagnosed hypothyroidism
Box 4 Drugs affecting dosage of levothyroxine
Drugs preventing absorption of levothyroxine
Drugs increasing clearance of levothyroxine
Patient does not feel well despite well controlled thyroid stimulating
hormone level (0.1 to 2.5 mU/l)
Treating hypothyroidism in older patients and those with ischaemic heart
disease

Hypothyroidism in pregnancy

Current controversies

Who should be screened for hypothyroidism?
Box 5 Selected populations requiring screening for hypothyroidism
Should combined triiodothyronine with levothyroxine be used?
How useful is porcine thyroid extract?
When should general practitioners refer?

Tips for non-specialists
Additional educational resources
Resources for healthcare professionals
Resources for patients
A patient's perspective
Unanswered questions
Current ongoing clinical trials

<http://www.bmj.com/cgi/content/extract/337/jul28_1/a801?fmr>

Rapid Responses to this article are available without subscription here:

<http://www.bmj.com/cgi/eletters/337/jul28_1/a801>

--
Rod

Hypothyroidism is a seriously debilitating condition with an insidious
onset.
Although common it frequently goes undiagnosed.
<www.thyromind.info> <www.thyroiduk.org> <www.altsupportthyroid.org>
 | 
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