VA Ambulatory Report Pearls 8.19 – Thyroid Hormone Resistance

Comprehensive Table of the Differential Dx for Elevated TSH/FT4 (from BMJ)

The following are the etiologies to think about when a patient presents with TSH/FT4.


  • Per LT’s endless fund of knowledge – the physiologic dose of LT4 is 175mcg per 24 hours.
  • Jeff brought up two fantastic articles to review from the Annals of Internal Medicine on Diagnosis/Management/Treatment of Hypothyroidism and Hyperthyroidism” (these are attached)
  • Remember that in elderly patients, the classic hypothyroid and hyperthyroid systems can be flipped and patients with hypothyroidism can present with hyperthyroid symptoms and vice versa. Remember, the picture of an elderly patient with hypothyroidism presenting as “wired and tired.”

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