#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!

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• 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
  

• 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