Hypothyroidism

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Oral oestrogen raises circulatory thyroid binding globulin (TBG) levels, thereby increasing the bound fraction of thyroxine and decreasing free thyroxine levels.
After starting oral HRT, TSH levels should be monitored regularly (for example at 6-12 weeks), to ensure that levels remain within an acceptable range. The dose of Levothyroxine may need to be increased.
Transdermal oestrogen does not affect TBG levels and would not be expected to alter thyroid function.

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