DiscoverThe Curbsiders Internal Medicine Podcast#208 Hypothyroidism Master Class with Susan Mandel MD
#208 Hypothyroidism Master Class with Susan Mandel MD

#208 Hypothyroidism Master Class with Susan Mandel MD

Update: 2020-04-20


Fall in love with the thyroid all over again, as we deconstruct hypothyroidism with thyroid expert, Susan Mandel MD, MPH (PENN). We review common causes, symptoms, diagnosis and treatment and how these may differ for those who are Pregnant, over age 65, or have existing Heart disease. Plus, Dr Mandel schools us on her approach to treatment with levothyroxine (T4), and even explains when she trials liothyronine (T3) replacement! Warm up those thumbs for the thyroid’s on!


Listeners can claim Free CME credit through VCU Health at (CME goes live at 1200 PM ET on the episode’s release date). 


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  • Written and Produced by: Elena Gibson MD 
  • Cover art and Infographic by: Dr Kate Grant MBChb MRCGP
  • Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP   
  • Editor: Emi Okamoto (written materials); Clair Morgan of
  • Guest: Susan Mandel MD, MPH



We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and check out 

for more information.


Time Stamps

  • 00:00 Intro, disclaimer, guest bio

  • 02:43 Guest one-liner; Pick of the week: Waiting for Godot (Play); Favorite Failure; Career Advice

  • 09:40 Case from Kashlak Part one; Hypothyroidism signs and symptoms

  • 13:20 When to Test for Hypothyroidism 

  • 17:43 Biotin interaction

  • 19:49 Which thyroid tests should we order?

  • 26:15 Subclinical hypothyroidism

  • 29:00 Etiology/Types of hypothyroidism 

  • 33:30 Case from Kashlak Part two; Initial Medication dosing; Physical Exam

  • 37:10 Levothyroxine replacement time of administration

  • 42:10 TSH goal 

  • 46:00 Levothyroxine manufacturers

  • 48:33 Dosing in older adults

  • 50:27 T3 treatment

  • 56:52 Pregnancy

  • 59:42 Dose adjustments

  • 61:43 Estrogen and thyroid binding protein 

  • 63:33 Who needs a referral?

  • 65:40 Plugs, Outro



Listeners will develop an approach to the diagnosis and management of patients with hypothyroidism.


Learning objectives

After listening to this episode listeners will…  

  1. Recognize the different etiologies of hypothyroidism.
  2. Identify signs and symptoms of hypothyroidism.
  3. Develop an approach to diagnosing and treating hypothyroidism.
  4. Define subclinical hypothyroidism and when to treat it. 
  5. Recognize how pregnancy influences hypothyroidism management.
  6. Be able to counsel patients on treatment for hypothyroidism.



Dr. Mandel reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 



Mandel S, Gibson EG, Grant K, Williams PN, Brigham SK, Okamoto E, Watto MF. “Hypothyroidism”. The Curbsiders Internal Medicine Podcast. April 20, 2020.

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#208 Hypothyroidism Master Class with Susan Mandel MD

#208 Hypothyroidism Master Class with Susan Mandel MD