Thyroid Disorders&nbsp;&nbsp;&nbsp;

What factors would lead you to extend the duration of antithyroid drug therapy in a patient with Graves' disease who is clinically euthyroid at 12 months but has risk factors for recurrence?

Would you recommend RAI ablation therapy to patients with PTC who are s/p hemi-thyroidectomy and decline completion thyroidectomy despite meeting criteria based on pathology results?

Is there a role for levothyroxine in managing the symptoms of a patient with euthyroid Hashimoto’s thyroiditis?

Are thyroid molecular tests (such as Afirma, ThyroSeq) validated for use on FNA thyroid nodule samples that are not Bethesda class 3-4?

Clinical scenario where an indeterminate pathology on initial FNA was followed by a “benign” result on a 2nd FNA.

Do you recommend checking both TSI and TBII antibodies for Graves' disease diagnosis and monitoring?

How do you medically manage uncontrolled Graves' disease in a patient awaiting surgery who is intolerant to methimazole and PTU and refusing RAI?

Patient had intolerance to methimazole and then developed agranulocytosis with PTU. FT4 is 2.9 (upper normal range is 1.7). I have started the patient...

What workup do you recommend for patients requiring higher-than-expected levothyroxine doses for their weight?

How often should TSH levels be monitored in patients with a history of Graves' disease who are in remission with negative TSI/TBII antibodies and off medical therapy?

How do you counsel patients with elevated Thyroglobulin Peroxidase antibody levels, diffuse thyroiditis features on ultrasound, non-specific symptoms of fatigue, but normal biochemical thyroid function labs?

What is the utility of checking reverse T3 in clinical practice?

Can you explain the block and replace approach in the treatment of thyrotoxicosis, including when it is most appropriate to use and how it compares to other treatment options?

What is the clinical significance of positive anti-thyroid antibodies in a patient that is post-thyroidectomy?

How should patients time the ingestion of their alendronate and levothyroxine given issues with food/drug interactions?

With the time intervals recommended after taking each medicine, I am wondering how patients should be counseled.

How soon after radioactive iodine therapy for hyperthyroidism should Methimazole be resumed?

Which brand/preparation of levothyroxine do you recommend to treat hypothyroid patients with alpha-gal allergy?

If they are already on a preparation that contains animal products, would you change it?

What strategies do you employ for adjusting the dosage of levothyroxine in hypothyroid patients who experience significant weight loss or are initiated on GLP-1 receptor agonists?

How often do you recommend monitoring thyroid function tests in these situations?

For patients with central hypothyroidism and a clear etiology (such as recent head irradiation), do you recommend brain imaging prior to starting thyroid hormone replacement therapy?

For hypothyroid patients on dual replacement therapy (levothyroxine & liothyronine), do you recommend monitoring TSH while holding off on the morning T3 dose?

Would you recommend changing a patient from the pill form of levothyroxine to Tirosint-SOL if they are started on a proton pump inhibitor?

Yue et al., PMID 38554774

What work up do you recommend for persistent subclinical hyperthyroidism with decreased RAI uptake and negative thyroid antibody tests?

How do you choose between antithyroid drugs, RAI, and surgery for hyperthyroidism patients with existing cardiovascular disease, given their varying effects on cardiovascular outcomes?

Chiung-Hui Peng et al., PMID 38436957

Do you adjust the dose or the timing of levothyroxine ingestion in patients on anti-acid medications?

What specific markers or symptoms guide your decision to adjust or stop prophylactic calcium supplementation and calcitriol in managing postoperative hypoparathyroidism following thyroidectomy?

Should all thyroid cancer patients have thyroglobulin levels measured pre-operatively?

Should serum calcitonin for surveillance of medullary thyroid cancer be done fasting ?

What is your approach to determining recurrent versus RAI-refractory differentiated thyroid cancer in patients presenting with metastatic disease several years after surgery?

Should patients with hypothyroidism hold their morning levothyroxine dose before going to the lab to check free T4/TSH?

There is literature showing small changes in both free T4 and TSH (despite steady state) in the first few hours after ingestion of L-T4. In occasional...

Is there a role for Vitamin D supplementation in the treatment of Hashimoto’s thyroiditis?

Would you do active surveillance or completion thyroidectomy in a patient with 1.6 cm tall cell PTC with posterior margin’s indeterminate and 7 mm isoechoic solid nodule on other side?

Patient is a 41F and overall good surgical risk candidate.

How do you counsel a patient with hypothyroidism who complains of persistent hypothyroid symptoms despite achieving normal TSH values with levothyroxine?

What is the next step in management of a thyroid nodule that was biopsied and classified as Bethesda III, but Afirma genetic testing reveals parathyroid signature?

Patient does not have hypercalcemia.

In a patient with low-risk papillary thyroid carcinoma in 1 thyroid lobe s/p hemithyroidectomy, how would a diagnosis of Graves' orbitopathy (euthyroid biochemically) affect your classification and TSH target for thyroid-cancer treatment?

Conflicting data exists on whether Graves' disease would increase the aggressiveness of the concomitant thyroid cancer vs having no effect/correlation...

How long should T3 be continued in hypothyroid patients who received no symptomatic benefit after starting T3/T4 combination therapy?

Would you give a second round of therapeutic RAI in a patient with PTC s/p total thyroidectomy and I-131 ablation who is found to have recurrent disease in cervical lymph nodes s/p repeat neck dissection?

What dose of RAI would you consider giving if recommended?

Should thyroid hormone replacement be initiated in patients with very prolonged critical illness with associated low thyroid hormone levels?

Is thyrotropin receptor antibody a good biomarker to predict development of thyroid eye disease?

What is the differential for elevated T3 (with suppressed T4 and normal TSH) in a patient not taking any thyroid hormones?

Female is in her later 40s with surgical oophorectomy taking Sertraline 50 mg daily and prn Trazodone and Lamotrigine. Has some weight loss and fatigu...

Should thyroxine hormone be started in women having fertility concerns with high-normal TSH and negative TPO antibody?

Can subclinical hypothyroidism cause myxedema coma?

Elderly male with primary hypothyroidism, HTN, and progressive worsening cognition over several months. PCP has been increasing LT4 dose as outpatient...