Endocrine
May 17, 2025Endocrine Hyperthyroidism
May 17, 2025Endocrine
Hypothyroidism
Subclinical
-
Increased TSH with normal free T4
Management
- Pursue ICPI
- Start standard thyroid hormone replacement therapy if TSH > 10 mIU/L with normal free T4
Assessment and Investigations
- Repeat TSH and free T4 testing after 6-8 weeks and adjust thyroid hormone dose accordingly.
- If TSH is above reference range, increase thyroid hormone dose by 12,5 mcg to 25 mcg.
- After identification of the appropriate maintenance dose, further evaluation is required every year, or sooner if patient’s status changes.
Clinical
-
Increased TSH with low free T4
Management
- Pursue ICPI
- Start standard thyroid hormone replacement therapy: initial dose can be the full dose (1.6 mcg/kg) in young, healthy patients, but a reduced dose of 25 -50 mcg should be initiated in elderly patients or known cardiovascular disease.
Assessment and Investigations
- Repeat TSH and free T4 testing after 6-8 weeks and adjust thyroid hormone dose accordingly.
- If TSH is above reference range, increase thyroid hormone dose by 12.5 mcg to 25 mcg
- After identification of the appropriate maintenance dose, further evaluation is required every year, or sooner if patient’s status changes
Severe
Management
- Hold ICPI, restart when downgraded to grade 2
- Treat same as grade 2 – Clinical
- Discuss with endocrinologist