Hypothyroidism: Diagnosis and Treatment

Diagnosis

• A medical history and physical examination are the first steps in diagnosis. However, because the clinical symptoms are highly variable, diagnosis ultimately relies on laboratory testing.
• Blood testing to measure the blood levels of thyroid hormones will diagnose the disease. However, in some cases, certain conditions can lead to altered thyroid hormone tests in the absence of thyroid disease. These include malnutrition, chronic illness, diabetes, drugs, and pregnancy.
• Because high cholesterol levels can occur in hypothyroidism, most patients should also be tested for cholesterol levels.
• Further laboratory testing may be useful in selected cases. For example, ultrasound of the neck and thyroid is sometimes recommended.
• In some cases, biopsy of the thyroid may be recommended to rule out thyroid cancer.

Treatment

• In most cases, hypothyroidism requires lifelong thyroid hormone replacement. The usual regimen begins at 50μg/day and increases by 25 to 50 μg/day every four to eight weeks until an appropriate dose is reached. While the dose is being increased, regular blood testing is necessary to monitor the body’s response to the medication.
• Iodine deficiency is treated with potassium iodide.
• Myxedema coma is a medical emergency that requires hospitalization, intravenous thyroid hormone and steroids, and fluids.