At 16:52 06/03/04, you wrote:
>Another dumb question from me ;-)
>
>looking to make sure that 90% of thyroxine treated patients have had TFT
>in last year - I started to wonder about treatment
>options based on the results.
>
>If TSH is below normal yet T4 is OK - is any treatment change necessary?
>If not then why measure TSH at all?
>
>Confused as ever
>
>TIA
>
>Jeff
Jeff
Pragmatically:
If TSH is above normal replacement is probably inadequate - even if the
patient has no obvious signs or symptoms. If TSH is borderline highish be
guided by symptoms / trial of increased dose.
If TSH is normal and patient feels well all is great.
If TSH is low you may be over treating and our lab sometimes suggests "fine
dose adjustment if patient compliance is good" but some patients just feel
better with lowish TSH. There may be an increased risk of
osteoporosis. Do remember however that patients on thyroxine after
treatment of thyroid cancer should be on high dose T4 to completely
suppress TSH.
HTH (And would be interested if anyone has significantly different views)
Julian
|