Outcome evaluation

• Desired outcomes include relieving signs and symptoms and achieving a euthyroid state.

• Success of therapy for thyroid disorders must be based not only on short-term improvement of the patient's clinical status and abnormal laboratory values but also on achievement of a long-term euthyroid state. Maintaining the TSH level in the normal range improves symptoms and reduces the risk of long-term complications.

• Because pharmacotherapy often is lifelong, especially in patients with hypothyroid-ism, patients must undergo periodic monitoring to avoid the long-term complications of hypothyroidism and hyperthyroidism. In the hypothyroid patient, such monitoring may involve simply asking the patient about signs and symptoms, and a yearly measurement of the TSH level.

• Any change in the patient's clinical status, such as a new pregnancy or a major change in body weight, necessitates a reevaluation of therapy. Patients at high risk for complications, such as pregnant women, the elderly, and patients with underlying cardiac disease, must be monitored more closely.

• Patients should be educated and periodically reminded about the importance of adherence and long-term tight control, the need for periodic clinical and laboratory monitoring, and the importance of staying on one LT4 product.

• In the hyperthyroid patient, relieving signs and symptoms, and achieving a euthyroid state are the desired outcomes. The method of achieving these outcomes may change over time with the use of antithyroid drugs versus radioactive iodine.

• Patients with hyperthyroidism also must undergo periodic clinical and laboratory monitoring, with more frequent monitoring if there is a change in the patient's clinical status.

• Patients who receive antithyroid drugs must be monitored for adverse drug events such as agranulocytosis.

• Patients who receive radioactive iodine must be monitored for the development of hypothyroidism.

• In patients with thyroid cancer, the desired outcomes with LT4 therapy often are different from those in the hypothyroid patient.

• LT4 doses sufficient to suppress tumor growth may result in a suppressed TSH and mild hyperthyroidism. These patients must be monitored closely for complications of the mild hyperthyroid state, such as bone mineral loss and development of atrial fibrillation.

Abbreviations Introduced in This Chapter

A N D A Abbreviated New D ru g Applicatio n

Ami-TP OAb A n t il by roid per ox ida.se îi nt ibôdy

AUC Area under the (time-concent rat ion) curve

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