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Investigation and Management of Primary Thyroid Dysfunction

• Published: 2006
• Revised: 2008
• Topic: Thyroid
• Scope: Testing for suspected hypo or hyperthyroidism, TSH use in thyroxine therapy for treatment of hypothyroidism or monitoring thyroxine therapy in thyroid cancer, pregnancy, and in patients receiving lithium or amiodarone
• Abstract: This guideline replaces previous thyroid guidelines produced by the Alberta Medical Association and addresses testing and monitoring of patients with suspected hypo or hyperthyroidism.
• Target Population:
• Exclusions:
  • • Neonatal patients
  • • TSH is NOT reliable in cases of suspected pituitary disease. FT4 is recommended
  • • TSH may be an unreliable indicator of thyroid status in patients with severe nonthyroidal illness (e.g.,
      CCU, ICU, acute severe psychiatric illness)
  • • TSH may not reflect the clinical status within 3 months of therapy for hyperthyroidism with radioactive
      iodine. During this time FT4 is recommended
  • • Thyroxine suppression therapy is NOT recommended for thyroid nodules or euthyroid nodular goiter
• Working Group Membership: Family physicians, laboratory specialists, endocrinologist