#208

Описание: Fall in love with the thyroid all over again, as we deconstruct hypothyroidism with thyroid expert, Susan Mandel MD, MPH (PENN). We review common causes, symptoms, diagnosis and treatment and how these may differ for those who are Pregnant, over age 65, or have existing Heart disease. Plus, Dr Mandel schools us on her approach to treatment with levothyroxine (T4), and even explains when she trials liothyronine (T3) replacement! Warm up those thumbs for the thyroid exam...it’s on!



Listeners can claim Free CME credit through VCU Health at https://curbsiders.vcuhealth.org/ (CME goes live at 1200 PM ET on the episode’s release date).



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Credits Written and Produced by: Elena Gibson MD Cover art and Infographic by: Dr Kate Grant MBChb MRCGP Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Emi Okamoto (written materials); Clair Morgan of nodderly.com Guest: Susan Mandel MD, MPH

Sponsor We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out https://curbsiders.vcuhealth.org/ for more information.



Time Stamps 00:00 Intro, disclaimer, guest bio 02:43 Guest one-liner; Pick of the week: Waiting for Godot (Play); Favorite Failure; Career Advice 09:40 Case from Kashlak Part one; Hypothyroidism signs and symptoms 13:20 When to Test for Hypothyroidism 17:43 Biotin interaction 19:49 Which thyroid tests should we order? 26:15 Subclinical hypothyroidism 29:00 Etiology/Types of hypothyroidism 33:30 Case from Kashlak Part two; Initial Medication dosing; Physical Exam 37:10 Levothyroxine replacement time of administration 42:10 TSH goal 46:00 Levothyroxine manufacturers 48:33 Dosing in older adults 50:27 T3 treatment 56:52 Pregnancy 59:42 Dose adjustments 61:43 Estrogen and thyroid binding protein 63:33 Who needs a referral? 65:40 Plugs, Outro

Goal Listeners will develop an approach to the diagnosis and management of patients with hypothyroidism.



Learning objectives After listening to this episode listeners will…

Recognize the different etiologies of hypothyroidism. Identify signs and symptoms of hypothyroidism. Develop an approach to diagnosing and treating hypothyroidism. Define subclinical hypothyroidism and when to treat it. Recognize how pregnancy influences hypothyroidism management. Be able to counsel patients on treatment for hypothyroidism.

Disclosures Dr. Mandel reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.



Citation Mandel S, Gibson EG, Grant K, Williams PN, Brigham SK, Okamoto E, Watto MF. “Hypothyroidism”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list April 20, 2020.