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Pericardial and pleural effusion, hypothermia, and coma may develop in patients with more severe disease () ().

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Therefore, the normalization of thyroid function with l-T 4 replacement therapy in hypothyroid patients may improve kidney function ().

In a cross-sectional, population-based study of 29 480 adults without previously known thyroid disease, the prevalence of CKD was higher in people with TSH in the middle and highest thirds of the reference range and CKD was more common in those with SHypo ().

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This study revealed that the volume of benign nodules greater than 1 cm in diameter was significantly reduced by TSH-suppressive l-T 4 doses in combination with iodine compared with T 4 alone, iodine alone, or placebo in an iodine-deficient German population ().

About 30% to 50% of hypothyroid women being treated during pregnancy have a TSH concentration outside of the desired reference range ().

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As an alternative, the recent Endocrine Society (ES) guidelines recommend the use of the FT 4 index or the total T 4 adjusted for pregnancy to estimate FT 4 values in pregnancy ().

Some studies have reported an increased risk of craniosynostosis, hyperactivity, delinquency, aggressiveness, and poor attention in children with CoH who were overtreated with l-T 4 ().

Moreover, the diagnostic criteria for Wilson's syndrome were considered vague or imprecise with potential risk of leading patients to mistaken or delayed diagnoses of other conditions.

Some of the following factors may play a role in poor adherence to l-T 4 therapy: 1) patients could have poor adherence to l-T 4 therapy because they may not be satisfied with the sense of well-being achieved during the initial period of replacement therapy; 2) the cost of the medication may be an important economic consideration in some countries; and 3) patients may be intolerant of side effects related to a sudden increase in metabolism induced by l-T 4 therapy, especially if the initially selected dosage is TSH-suppressive.

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All of these observations suggest that TSH is not a perfect marker of peripheral tissue euthyroidism in thyroidectomized patients and that in these patients there may be a wide tissue heterogeneity in T 3 production ().

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You need to have your doctor write a lab order for you to have your thyroid checked so that he can monitor it if it is off.

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