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In people with hypothyroidism that is being treated with thyroid hormones and that are not showing symptoms or hypothyroidism, how often should these tests be performed:

  • TSH blood test
  • T4 blood test
  • ultrasound of the thyroid
  • scintigraphy of the thyroid

(if at all, of course)

If the cause of the hypothyroidism matters, let's say Hashimoto thyroiditis.

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This also depends on the question if hypothyroidism is subclinical or overt. Recently, the European Thyroid Association has published a guideline on the management of subclinical hypothyroidism. In asymptomatic patients thyroid function tests (TFTs) should be repeated in 6 months intervals.

Decisions shouldn't be based on TSH levels alone, but also on concentrations of free T4 and free T3. In difficult cases calculated parameters including SPINA-GT, SPINA-GD and Jostel's TSH index might be helpful as well. A recent paper demonstrated age, sex, SPINA-GD and aetiology of hypothyroidism to be independent predictors of substitution dose with L-T4.

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