For patients receiving long-term thyroid therapy for hypothyroidism, monitoring is through sTSH unless there is hypotha-lamic-pituitary disease. It takes 2 to 4 weeks after initiating treatment (or changing dose) before clinically significant change occurs in sTSH level. In most patients, checking sTSH once monthly is sufficient until steady state is reached. After the patient is stabilized, sTSH can be checked annually unless the patient develops new symptoms or dosing changes.
Patients with benign nodules should be followed annually with careful palpation of the thyroid gland. Unless there is a change in size, no additional testing is required. Ultrasound of the thyroid is not recommended for follow-up of nodules less than 1.0 cm. Repeat ultrasound is required in patients with an enlarging nodule, evidence of a new thyroid mass, or who complain of pain or pressure. Unless the patient is experiencing symptoms of hyperthyroid or hypothyroid, repeat testing of sTSH or FT4 is not indicated.
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