Don't have the right answer/? pls give opinion - antigen11

[ArchivalUser]

I would go with reach4stars because Lowering the dose will bring back his bipolar.and we cannot just sit and monitor when his TSH is way too high eventhough the pt is asymptomatic.
so I think it could be E.

[ArchivalUser]

It's unlikely to get such an incomplete question.....I mean how can you start someone on levothyroxine without doing the complete investigations??? And hypothyroidism is not a sign of toxicity of LI. It's a side effect from long term use and can happen even if the LIl levels are within Therapeutic range.

[ArchivalUser]

Thank you ,interesting topic.

My ans is D...continue lithium and monitor the patient as cut off tsh is 10.

Reference,

Baseline thyroid function tests should be measured prior to starting lithium therapy to ensure that undetected hypothyroidism is not contributing to mood symptoms. Pertinent thyroid function tests include TSH and free T4 levels, as well as antiperoxidase and antithyroglobulin in the presence of an elevated TSH. Subsequent monitoring of thyroid function tests is usually conducted 3 months after starting lithium and every 6-12 months thereafter.[4,5]

Although lithium-induced hypothyroidism is usually reversible upon cessation of lithium, the development of hypothyroidism is not a contraindication to continuing lithium, and most experts advocate thyroid augmentation therapy.

Current practice guidelines do not specify criteria for managing thyroid replacement therapy in patients with lithium-induced hypothyroidism.
In the presence of elevated TSH levels without clinical signs of hypothyroidism, some authorities advise monitoring serum TSH levels every 3 months without intervening with adjunctive thyroxine, unless TSH levels rise above 10 mU/L.xxxxx

4] Others advocate thyroid supplementation whenever TSH levels rise above normal, particularly in the presence of affective symptoms. T4 is generally preferred to T3 because the former tends to produce steadier hormone levels.[4] Typically, thyroxine (T4) is begun at .025 mg, and increased by .025 mg every 3 to 6 weeks until TSH levels have normalized.[4]In the presence of rapid cycling or persistent affective symptoms, thyroxine is increased until the serum T4 level is in the upper quartile of the normal reference range.[6]

[ArchivalUser]

Thanks forever07 ( u took forever to answer.....!!!!!)

That was my whole point!!

[ArchivalUser]

Thank you. Hope u r right. ... Which book did u find this ? I am trying to find but can't .