Correspondence (letter to the editor): Additional Iodide Therapy Not Required

I have a slightly different approach regarding two issues, and my clinical practice therefore differs slightly.

Target value for the concentration of thyroid stimulating hormone (TSH): I choose a measurement of 1–2 mU/L to compensate for autoimmune hypothyroidism. Since in patients who have had surgery one objective is to avoid repeated surgery, I believe that the TSH concentration and growth stimulus should be lower. I therefore select a low-normal target range of 0.5–1 mU/L. In patients in whom dosage adjustment proves difficult, in whom the required dosage is high, and in patients with cardiac risk I would rather accept a normal TSH value that is slightly on the high end of the acceptable range than one that is on the lower end; an actual low value is never acceptable.) After correcting the dosage I will measure the TSH concentration 6 weeks later.

Combination with iodide: In view of the still prevailing but less severe iodine deficiency, I don’t see the need for additional medication with iodide in thyroid volumes below 6 ml and substitution of more than 50% of the thyroid hormone requirement, especially as during the transformation of T4 into T3, iodide is split off and released. In larger residual volumes—for example after hemithyroidectomy—I combine a residual volume of more than 8 ml with iodide.