CME | A Crash Course in Thyroid Confusion

In this episode of CME On the GO, the hosts discuss a practical approach to hypothyroidism, using a case of a 50-year-old woman with nonspecific symptoms (weight gain, fatigue, edema, constipation). They emphasize thorough history and physical exam, then outline key thyroid testing: TSH as the initial screening test (often with reflex free T4), free T4 for confirmation and special situations (including pregnancy), and limited uses for T3 tests. They review antibody testing (TPO for Hashimoto's, thyroglobulin antibodies in select cases) and note tests for Graves disease outside this episode. They cover sick thyroid considerations, subclinical hypothyroidism controversy, pregnancy management with tighter TSH goals and dose increases, and treatment preferences favoring standardized levothyroxine over desiccated thyroid, with limited/controversial use of combination T4/T3 therapy.

Learning Objectives

1. Interpret key thyroid laboratory tests—including TSH, T4, fT4, T3, fT3, and thyroid antibodies—within the framework of thyroid physiology and the hypothalamic-pituitary-thyroid axis.

1. Compare the efficacy, safety, and clinical indications of thyroid hormone replacement options such as levothyroxine, liothyronine (Cytomel), and desiccated thyroid extract.

1. Explain the clinical significance of subclinical hypothyroidism and apply evidence-based reasoning to common patient scenarios with borderline thyroid function.

The AAFP has reviewed A Crash Course in Hypothyroid Confusion and deemed it acceptable for up to 0.50 Enduring Materials, Self-Study AAFP Prescribed credits. Term of Approval is from 04/20/2026 to 6/4/2027. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The AAFP is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Academy of Family Physicians designates this Enduring Materials for a maximum of 0.50 AMA PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CME activities approved for AAFP credit are recognized by the AOA as equivalent to AOA Category 2 credit.

After listening to the podcast episode, complete and submit the evaluation to claim 0.5 AAFP credit by following the provided link.

https://www.aafp.org/assessment/take/19856/e

References and Resources

Hypothyroidism: Diagnosis and Treatment: https://www.aafp.org/pubs/afp/issues/2021/0515/p605.html

Thyroiditis: Evaluation and Treatment: https://www.aafp.org/pubs/afp/issues/2021/1200/p609.html

Hypothyroidism A Review: https://jamanetwork.com/journals/jama/fullarticle/2838457?utm_source=openevidence&utm_medium=referral

Hyperthyroidism A Review:

https://jamanetwork.com/journals/jama/fullarticle/2810692?utm_source=openevidence&utm_medium=referral

Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism: https://www.nejm.org/doi/full/10.1056/NEJMoa1603825

Hypothyroidism: https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0140673624016143?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0140673624016143%3Fshowall%3Dtrue&referrer=https:%2F%2Fpubmed.ncbi.nlm.nih.gov%2F

Article on lab testing: https://pmc.ncbi.nlm.nih.gov/articles/PMC10517335/

https://pmc.ncbi.nlm.nih.gov/articles/PMC7640752/

Ahluwalia R, Baldeweg SE, Boelaert K, et al. Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement. Clin Endocrinol (Oxf). 2023;99(2):206-216. doi:10.1111/cen.14935

Disclosure: It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest and, if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity.  All individuals in a position to control content for this session have indicated they have no relevant financial relationships to disclose. 

Disclaimer: Copyright 2026. AAFP. The views presented in this broadcast are the speaker's own and do not represent those of AAFP.  The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.  AAFP makes no representation as to the accuracy or completeness of the information and is not responsible for results that may arise from its use.  Consult an appropriate professional concerning your specific situation and respective governing bodies for applicable laws. Reference to any specific product or entity does not constitute an endorsement or recommendation by AAFP unless specifically stated otherwise. AAFP and the AAFP logo are registered trademarks of American Academy of Family Physicians.