Much of this guideline supports our current practice. There were a few new bits for me and I have listed these below, then summarised the guideline.
The guideline covers both children and adults, but as we mainly deal with adults with thyroid problems, I have not covered any of the details of how to manage or investigate children. Just be aware that the advice for kids is there if you need it.
What was new in this guideline for me:
- Symptoms may lag behind treatment changes by weeks, or even months.
- The body has a good reservoir of thyroxine, so symptoms that change day by day are unlikely to be due to thyroid disease.
- Consider checking TFTs in children with altered behaviour or school performance.
- Consider checking TFTs in women with menopausal symptoms if you feel it could be related to thyroid dysfunction. Many symptoms overlap.
- Do not do TFTs if the only reason for doing them is that the patient has Type 2 Diabetes (T2DM). Evidence shows that there is no correlation between T2DM and thyroid dysfunction. This is obviously not the case for Type 1 Diabetes, where there is good correlation.
- Treating hypothyroidism. For adults under 65 with no history of CVD, use a starting dose of levothyroxine of 1.6mcg/kg, rounded to the nearest 25mcg.
- Monitoring. Once there are 2 TSH levels in the normal reference range, 3 months apart, then go to annual monitoring.
- Subclinical hypothyroidism. If they have TSH > 10 on 2 occasions, 3m apart, then consider treating. If TSH is < 10 but over 5 on 2 occasions, 3m apart and the patient is symptomatic and under 65, then consider treating. In the over 65s, they advise being more cautious, because side-effects from treating are more common (eg AF).
- Subclinical hyperthyroidism. Consider seeking specialist advice for a child or young person. For an adult, consider seeking specialist advice if there are 2 TSH readings < 0.1, 3m apart and the patient is either symptomatic, or has goitre, or has positive thyroid antibodies.