Replace thyroid hormone to TSH target 0.5–4.0 mIU/L (trimester-specific in pregnancy). Levothyroxine 1.6 µg/kg/day; start low (25–50 µg) in elderly/CAD. Retitrate q6–8 wk until target reached, then q6–12 mo.
Authored pathway active · endo.hypothyroidism.outpatient.outpatient
Replace thyroid hormone to TSH target 0.5–4.0 mIU/L (trimester-specific in pregnancy). Levothyroxine 1.6 µg/kg/day; start low (25–50 µg) in elderly/CAD. Retitrate q6–8 wk until target reached, then q6–12 mo.
Guidelines: American Thyroid Association (ATA) 2014 Guidelines for the Treatment of Hypothyroidism · ATA 2017 Guidelines for Thyroid Disease in Pregnancy and Postpartum · Endocrine Society 2024 Clinical Practice Update — Hypothyroidism
Phenotypes (6)
- Overt primary hypothyroidism
- Subclinical hypothyroidism — treat (TSH > 10, OR symptomatic + TPO+, OR pregnancy)
- Subclinical hypothyroidism — watch (TSH 4.5-10, asymptomatic, non-pregnant)
- Central hypothyroidism
- +2 more
Red flags (5)
- Suspected myxedema coma (AMS + hypothermia + hyponatremia + hypoventilation)CRITICAL
- New angina or worsening CAD after starting levothyroxineHIGH
- Suspected adrenal insufficiency (postural hypotension, hyponatremia, fatigue) — unmasked or co-existingCRITICAL
- Newly pregnant on levothyroxine OR new pregnancy with elevated TSHHIGH
- +1 more
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