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Chapter 6: Endocrine
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Type 2 Diabetes Mellitus Treatment Guidance
Management of thyroid disorders
Guidance on the management of menopause
Management of osteoporosis
Prevention of glucocorticoid induced osteoporosis
Gender dysphoria and transgender prescribing
6.1 Drugs used in diabetes
6.2 Thyroid and antithyroid drugs
6.3 Corticosteroids
6.4 Sex hormones
6.5 Hypothalamic and pituitary hormones and anti-oestrogens
6.6 Drugs affecting bone metabolism
6.7 Other endocrine drugs
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Management of thyroid disorders
Interpretation of biochemical tests
High thyroid-stimulating hormone (TSH)
- with high free T4
- Assay interference
- ? TSH secreting pituitary tumour
- ? Thyroid hormone resistance
- with normal free T4
- Subclinical hypothyroidism (TSH greater than 4.5 mU/L less than 20 mU/L)
- with low free T4
- primary hypothyroidism or thyroiditis (TSH usually greater than 20 mU/L)
Normal TSH
- with high free T4
- Assay interference
- ? TSH secreting pituitary tumour
- ? Thyroid hormone resistance
- with normal free T4
- normal
- with low free T4
- Sick euthyroid
- secondary hypothyroidism
Low TSH
- with high free T4
- Thyrotoxicosis
- Thyroiditis
- with normal free T4
- Free T3 raised: thyrotoxicosis, thyroiditis
- Free T3 normal: subclinical hyperthyroidism
- with low free T4
- secondary hypothyroidism
