Todays clinical pearl comes from Justin Groce, NP who collaborated with me on the recently released Thyroid Optimization Course. I hope it helps you with your hypothyroid patients:
When it comes to managing and optimizing patients who have hypothyroidism, most patients are unfortunately being FAILED by their providers. If you have a patient that has overt hypothyroidism, you absolutely must obtain a thyroid peroxidase antibody (TPO) test. This will rule in/out Hashimoto’s disease!
Hashimoto’s is an autoimmune disease that destroys the thyroid gland and is the most common cause of hypothyroidism in iodine-sufficient regions (the USA). The problem is that most providers will simply diagnose someone with hypothyroidism and not think twice about this patient possibly having an autoimmune disease. They never tested for the TPO!
I see this way too often. A patient has been on a thyroid medication for years while still having symptoms, but has an undiagnosed autoimmune condition that has been flying under the radar all this time that could have benefited from other treatment modalities…
Even worse…they’ve never had a thyroid ultrasound?!!
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If the patient is positive for TPO, how does this change treatment?
You should work them up for autoimmune disease. The workup is different and treatment options can be different. Discussed in the new thyroid course.