Management of thyroid disorders

High TSH

• with high free T₄
  • Assay interference
  • ? TSH secreting pituitary tumour
  • ? Thyroid hormone resistance
• with normal free T₄
  • Subclinical hypothyroidism (TSH greater than 4.5 less than 20)
• with low free T₄
  • primary hypothyroidism or thyroiditis (TSH usually greater than 20)

Normal TSH

• with high free T₄
  • Assay interference
  • ? TSH secreting pituitary tumour
  • ? Thyroid hormone resistance
• with normal free T₄
  • Normal
• with low free T₄
  • Sick euthyroid
  • secondary hypothyroidism

Low TSH

• with high free T₄
  • Thyrotoxicosis
  • Thyroiditis
• with normal free T₄
  • Free T₃ raised: thyrotoxicosis, thyroiditis
  • Free T₃ normal: subclinical hyperthyroidism
• with low free T₄
  • secondary hypothyroidism

Patients are seen in the General Medicine and Endocrinology Clinic every Thursday afternoon.

Thursday morning (weekly)

• Thyrotoxicosis
• Thyroiditis
• Difficult hypothyroidism
• Goitres and nodules

Surgical clinic

• Mr G. Barrett
• Mr A. Husband
• Mr J. Smith
• Mrs H. Wilson

Combined thyroid eye disease clinic (monthly)

• Mr A Quinn and Dr B Vaidya

Telephone advice

• Dr Vaidya, Dr Donohoe, Dr Warren, Dr Brooke or Professor Hattersley (for antenatal) can be contacted 1400-1445, Monday - Friday on 07818 002363.
• At other times, try direct lines or secretary.

Consultants will also give advice by email. Queries should be sent to rde-tr.diabetesadvice@nhs.net