The Curbsiders Internal Medicine Podcast20 Apr 2020

#208 Hypothyroidism Master Class with Susan Mandel MD - How to dominate the diagnosis and management

Fall in love with the thyroid all over again, as we deconstruct hypothyroidism with thyroid expert, Susan Mandel MD, MPH (PENN). We review common causes, symptoms, diagnosis and treatment and how these may differ for those who are Pregnant, over age 65, or have existing Heart disease. Plus, Dr Mandel schools us on her approach to treatment with levothyroxine (T4), and even explains when she trials liothyronine (T3) replacement! Warm up those thumbs for the thyroid exam...it’s on!

Credits

Written and Produced by: Elena Gibson MD
Cover art and Infographic by: Dr Kate Grant MBChb MRCGP
Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
Editor: Emi Okamoto (written materials); Clair Morgan of nodderly.com
Guest: Susan Mandel MD, MPH

Sponsor: VCU Health CE

Time Stamps

00:00 Intro, disclaimer, guest bio
02:43 Guest one-liner; Pick of the week: Waiting for Godot (Play); Favorite Failure; Career Advice
09:40 Case from Kashlak Part one; Hypothyroidism signs and symptoms
13:20 When to Test for Hypothyroidism
17:43 Biotin interaction
19:49 Which thyroid tests should we order?
26:15 Subclinical hypothyroidism
29:00 Etiology/Types of hypothyroidism
33:30 Case from Kashlak Part two; Initial Medication dosing; Physical Exam
37:10 Levothyroxine replacement time of administration
42:10 TSH goal
46:00 Levothyroxine manufacturers
48:33 Dosing in older adults
50:27 T3 treatment
56:52 Pregnancy
59:42 Dose adjustments
61:43 Estrogen and thyroid binding protein
63:33 Who needs a referral?
65:40 Plugs, Outro

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