The video version of this podcast can be found here:· https://youtu.be/1Cwvoflk3LQ This episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode, I go through the NICE guideline on Thyroid disease: assessment and management [NG145], always focusing on what is relevant in Primary Care only. I am not giving medical advice; this episode is intended for health care professionals; it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: ● Apple podcast: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148● Spotify: https://open.spotify.com/show/2kmGZkt1ssZ9Ei8n8mMaE0?si=9d30d1993449494e● Amazon Music: https://music.amazon.co.uk/podcasts/0edb5fd8-affb-4c5a-9a6d-6962c1b7f0a1/primary-care-guidelines?ref=dm_sh_NnjF2h4UuQxyX0X3Lb3WQtR5P● Google Podcast: https://www.google.com/podcasts?feed=aHR0cHM6Ly9mZWVkcy5yZWRjaXJjbGUuY29tLzI1ODdhZDc4LTc3MzAtNDhmNi04OTRlLWYxZjQxNzhlMzdjMw%3D%3D● Redcircle: https://redcircle.com/shows/2587ad78-7730-48f6-894e-f1f4178e37c3There is a YouTube version of this and other videos that you can access here: ● The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The resources consulted can be found here:Thyroid disease: assessment and management -NICE guideline [NG145] can be found here:● https://www.nice.org.uk/guidance/NG145 Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] ● Music provided by Audio Library Plus ● Watch: https://youtu.be/aBGk6aJM3IU ● Free Download / Stream: https://alplus.io/halfway-through TranscriptIf you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description.Hello and welcome, I’m Fernando, a GP in the UK. Today we are going to go through the NICE guideline on Thyroid disease, always focusing on what is relevant in Primary Care only.Right, we are not going to waste any time so let’s jump into it.We will check TFTs if there is:● a clinical suspicion of thyroid disease, bearing in mind that 1 symptom alone may not be indicative of thyroid disease● type 1 diabetes or other autoimmune diseases, (but we will not offer testing only because of type 2 diabetes).● new-onset AF● depression or unexplained anxiety● abnormal growth in children and young people, or with an unexplained change in behaviour or school performance.● And we will be aware that in menopausal women symptoms of thyroid dysfunction may be mistaken for menopauseWe will not test for TFTs during an acute illness unless we suspect the acute illness is due to thyroid dysfunction, because it may affect the test results.So, what tests do we do as initial screening when thyroid dysfunction is suspected?This will depend on whether we suspect a primary cause, that is, a cause arising from the thyroid gland, or a secondary cause, that is, a cause arising from the pituitary gland. Although the path lab will have processes to decide what tests are included when we request TFTs, it is important for us to understand what tests results we should expect according to the clinical presentation.So, we will always measure TSH. Then, if a primary cause is suspected in an adult:● if the TSH is high, that is, suggestive of hypothyroidism, we will need the free thyroxine (FT4) level● if the TSH is low, that is, suggestive of hyperthyroidism, we will need FT4 and free tri-iodothyronine (FT3) However, if we suspect a secondary cause, that is, pituitary disease, or if we are testing a child or young person, we will need results for both TSH and FT4 and:● If the TSH is low, that is, suggestive of hyperthyroidism, we will need FT3 So, in summary, we test TSH and T4 in hypothyroidism but in hyperthyroidism we need to add FT3 too. We can repeat these tests if symptoms worsen or new symptoms develop (but no sooner than 6 weeks from the most recent test).We will also ask patients about their biotin intake because a high consumption of biotin from dietary supplements may lead to falsely high or low test results. Looking at the management, and monitoring different rules may apply to children and young people and given that we are likely...
