Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

for people with post surgical (total thyroidectomy) hypothyroidism what is the comparative effectiveness of medications used for TSH (T4) control when there are problems keeping the TSH level within range?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Synthroid, Cytomel combination or synthroid use alone. unable to keep TSH and T3 levels within range.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

psot surgical hypothyroid patients. Those who have had a total thyroidectomy due to Graves Disease.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

inability to control TSH and/or T3 levels using different dosages of Syntrhoid and/or Cytomel

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

ability to have TSH level within range (1.00)is optimum range for most people. Total lack of care by endocrinologists to care about the person. if the TSH is within the range mark, no matter how low or hi, as long as it is within the range, NO one cares. yet, the patient is still not being helped by the dosage. symptoms of either hypo or hyper thyroidism is present unless the TSH is well within the range, not just on the cusp.

Describe any health-related risks, side effects, or harms that you are concerned about.

heart related ongoing damage due to low TSH levels.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Cardiovascular disease, including stroke and hypertension
• Depression and other mental health disorders
• Functional limitations and disability
• Obesity

AHRQ Priority Populations

• Women

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

i have had my entire life turned upside down since being diagnosed with Graves Disease in 2005. i was perfectly healthy until the onset. had total thyroidectomy and still to this day (5 = yrs) my TSH and T3 are still uncontrollable, have been to 6 different Endocrinologists, have severe heart related problems to include A fib, RVR, Tachycardia and possible heart attack due to the inability or CARE of the endocrinologist. i do not have high blood pressure, i have low blood pressure, do not have cholestorl problems or any other "heart related" issues. Just hypothyroidism, post surgical and NO who cares except to get as much money out of medicare as they can!!!!!!!

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Endocrinologist lack of care for those who are NOT diabetics. Cardiologists who refuse to update thier procedures or practises

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

i can go to my doctors with the results and advise them that i am not a puppet nor is my life for the "pleasure"

Describe the timeframe in which an answer to your question is needed.

however long it takes.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

anyone who has thyroid problems.!

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

i can go to my doctors with the results and advise them that i am not a puppet nor is my life for the "pleasure"

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program

fox news.