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Hypothyroidism
Low free thyroxine (T4) : normal range (0.9-2.3)
High thyroid stimulating hormone (TSH): normal range (0.3-3)
Monitor TSH every 4-6 weeks until levels are normal then every 4-6 months thereafter
Drug tx: Levothyroxine
Boxed warning: use for weight loss
-decrease dose in CVD
Hyperthyroidism
FT4 is high, low TSH
Drug causes: iodine, amiodarone and interferons
Drug TX: propylthiouracil, methimazole
- inhibit synthesis of thyroid hormones
Boxed: severe liver injury and acute failure
Pregnancy : 1st trimester: PTU
2 and 3: methimazole
PTU is preferred in thyroid storm
Iodide: temporarily inhibit secretion of thyroid hormones
Ctx: hypersensitive to iodide, dermatitis herpetiforms, modular thyroid with heart disease
Pregnancy
Levothyroxine for hypo require 30-50% increase in dose
Hyper: PTU FIRST TRIMESTER, methimazole 2 and 3rd
Uncontrolled thyriud can cause low birth weight, loss, lower IQ, thyroid storm, maternal HTN, neurobehavioral disorders
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