GP Vivas · metabolic-and-endocrine-health
Hypothyroidism — structured viva
Structured oral on hypothyroidism: subclinical thresholds, levothyroxine dosing and absorption, pregnancy dose increases, T4/T3 null evidence, over-treatment risks, and myxoedema coma recognition.
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Study tools
Target exams
RACGP CCEFRACGP oralsMRCGP SCA
Prompt
The examiner opens: A patient says she feels tired on levothyroxine and wants to add T3. The viva branches through subclinical thresholds, dosing rules, absorption traps, combination therapy evidence, over-treatment harms and myxoedema coma.
Stem
You are the GP. A patient on levothyroxine says she still feels tired and wants T3 added. [1]
References5ShowHide
- [1]Jonklaas J, Bianco AC, Bauer AJ, et al. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association task force on thyroid hormone replacement Thyroid, 2014.PMID 25266247
- [2]Alexander EK, Pearce EN, Brent GA, et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum Thyroid, 2017.PMID 28056690
- [3]Grozinsky-Glasberg S, Fraser A, Nahshoni E, et al. Thyroxine-triiodothyronine combination therapy versus thyroxine monotherapy for clinical hypothyroidism: meta-analysis of randomized controlled trials J Clin Endocrinol Metab, 2006.PMID 16670166
- [4]Surks MI, Ortiz E, Daniels GH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management JAMA, 2004.PMID 14722150
- [5]Skelin M, Lucijanić T, Amidžić Klarić D, et al. Factors Affecting Gastrointestinal Absorption of Levothyroxine: A Review Clin Ther, 2017.PMID 28153426