Routine exams in patients with hypothyroidism
In people with hypothyroidism that is being treated with thyroid hormones and that are not showing symptoms or hypothyroidism, how often should these tests be performed:
TSH blood test
T4 blood test
ultrasound of the thyroid
scintigraphy of the thyroid
(if at all, of course)
If the cause of the hypothyroidism matters, let's say Hashimoto thyroiditis.
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This also depends on the question if hypothyroidism is subclinical or overt. Recently, the European Thyroid Association has published a guideline on the management of subclinical hypothyroidism. In asymptomatic patients thyroid function tests (TFTs) should be repeated in 6 months intervals.
Decisions shouldn't be based on TSH levels alone, but also on concentrations of free T4 and free T3. In difficult cases calculated parameters including SPINA-GT, SPINA-GD and Jostel's TSH index might be helpful as well. A recent paper demonstrated age, sex, SPINA-GD and aetiology of hypothyroidism to be independent predictors of substitution dose with L-T4.
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