Hypothyroidism - Revision history

Cdichang: /* Management */

2022-09-21T18:10:59Z

Management

← Older revision		Revision as of 18:10, 21 September 2022
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	==Management==		==Management==
	*Depends on etiology <ref>Ross D. Subclinical hypothyroidism in nonpregnant adults. In: UpToDate, UpToDate, Waltham, MA. (Accessed on September 21, 2022.)</ref>		*Depends on etiology <ref>Ross D. Treatment of primary hypothyroidism in adults. In: UpToDate, UpToDate, Waltham, MA. (Accessed on September 21, 2022.)</ref><ref>Ross D. Subclinical hypothyroidism in nonpregnant adults. In: UpToDate, UpToDate, Waltham, MA. (Accessed on September 21, 2022.)</ref>
	*If treatment started, initiate low dose as daily doses too high may lead to [[thyroid storm]]		*If treatment started, initiate low dose as daily doses too high may lead to [[thyroid storm]]

Cdichang: /* Management */

2022-09-21T14:56:21Z

Management

← Older revision		Revision as of 14:56, 21 September 2022
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	==Management==		==Management==
	*Depends on etiology		*Depends on etiology <ref>Ross D. Subclinical hypothyroidism in nonpregnant adults. In: UpToDate, UpToDate, Waltham, MA. (Accessed on September 21, 2022.)</ref>
	*If treatment started, initiate low dose as daily doses too high may lead to [[thyroid storm]]		*If treatment started, initiate low dose as daily doses too high may lead to [[thyroid storm]]

Cdichang: /* Clinical Features */

2022-09-21T14:54:18Z

Clinical Features

← Older revision		Revision as of 14:54, 21 September 2022
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	**Cold intolerance, [[hypothermia]]		**Cold intolerance, [[hypothermia]]
	**Weight gain		**Weight gain
	**[[Weakness]]		**[[Weakness]] or fatigue
	**[[Lethargy]]		**[[Lethargy]]
	**Hoarse voice		**Hoarse voice

Cdichang: /* Subclinical Hypothyroidism */

2022-09-21T14:53:03Z

Subclinical Hypothyroidism

← Older revision		Revision as of 14:53, 21 September 2022
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	*TSH 7.0 to 9.9 mU/L		*TSH 7.0 to 9.9 mU/L
	*<65 years old		**<65 years old
	**Start low dose [[levothyroxine]] at 25mcg daily with close outpatient follow up		***Start low dose [[levothyroxine]] at 25mcg daily with close outpatient follow up
	*>65 years old		**>65 years old
	**Risk of over treatment vs. benefit is unclear<ref>Mooijaart SP, Du Puy RS, Stott DJ, et al. Association Between Levothyroxine Treatment and Thyroid-Related Symptoms Among Adults Aged 80 Years and Older With Subclinical Hypothyroidism. JAMA 2019; 322:1977.</ref>		***Risk of over treatment vs. benefit is unclear<ref>Mooijaart SP, Du Puy RS, Stott DJ, et al. Association Between Levothyroxine Treatment and Thyroid-Related Symptoms Among Adults Aged 80 Years and Older With Subclinical Hypothyroidism. JAMA 2019; 322:1977.</ref>
	**If patient has signs and symptoms of hypothyroidism, consider endocrinology consult prior to initiating treatment		***If patient has signs and symptoms of hypothyroidism, consider endocrinology consult prior to initiating treatment

	*TSH between upper limit of normal to 6.9 mU/L		*TSH between upper limit of normal to 6.9 mU/L
	*<65 years old		**<65 years old
	**Initiate low dose [[levothyroxine]] at 25mcg daily only if patient has signs and symptoms of hypothyroidism		***Initiate low dose [[levothyroxine]] at 25mcg daily only if patient has signs and symptoms of hypothyroidism
	*>65 years old		**>65 years old
	**May be normal for older age, do not initiate treatment		***May be normal for older age, do not initiate treatment
	**Close outpatient follow-up		***Close outpatient follow-up for repeat labs

	==Disposition==		==Disposition==

Cdichang: /* Subclinical Hypothyroidism */

2022-09-21T14:52:17Z

Subclinical Hypothyroidism

← Older revision		Revision as of 14:52, 21 September 2022
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	===Subclinical Hypothyroidism===		===Subclinical Hypothyroidism===
	*TSH ≥10 mU/L		*TSH ≥10 mU/L
			**Start low dose [[levothyroxine]] at 25mcg daily with close outpatient follow up
	**Patients are at higher risk for atherosclerosis, myocardial infarction, and risk of progression to overt hypothyroidism		**Patients are at higher risk for atherosclerosis, myocardial infarction, and risk of progression to overt hypothyroidism
	**The American Thyroid Association (ATA), American Association of Clinical Endocrinologists (AACE) and the European Thyroid Association guidelines recommend initiating treatment<ref>Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid 2012; 22:1200.</ref><ref>Pearce SH, Brabant G, Duntas LH, et al. 2013 ETA Guideline: Management of Subclinical Hypothyroidism. Eur Thyroid J 2013; 2:215.</ref>		**The American Thyroid Association (ATA), American Association of Clinical Endocrinologists (AACE) and the European Thyroid Association guidelines recommend initiating treatment<ref>Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid 2012; 22:1200.</ref><ref>Pearce SH, Brabant G, Duntas LH, et al. 2013 ETA Guideline: Management of Subclinical Hypothyroidism. Eur Thyroid J 2013; 2:215.</ref>
	**Start low dose [[levothyroxine]] at 25mcg daily with close outpatient follow up

	*TSH 7.0 to 9.9 mU/L		*TSH 7.0 to 9.9 mU/L
			*<65 years old
			**Start low dose [[levothyroxine]] at 25mcg daily with close outpatient follow up
			*>65 years old
			**Risk of over treatment vs. benefit is unclear<ref>Mooijaart SP, Du Puy RS, Stott DJ, et al. Association Between Levothyroxine Treatment and Thyroid-Related Symptoms Among Adults Aged 80 Years and Older With Subclinical Hypothyroidism. JAMA 2019; 322:1977.</ref>
			**If patient has signs and symptoms of hypothyroidism, consider endocrinology consult prior to initiating treatment

	*TSH between upper limit of normal to 6.9 mU/L		*TSH between upper limit of normal to 6.9 mU/L
			*<65 years old
			**Initiate low dose [[levothyroxine]] at 25mcg daily only if patient has signs and symptoms of hypothyroidism
			*>65 years old
			**May be normal for older age, do not initiate treatment
			**Close outpatient follow-up

	==Disposition==		==Disposition==

Cdichang: /* Management */

2022-09-21T14:42:24Z

Management

← Older revision		Revision as of 14:42, 21 September 2022
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	===Primary (Central) Hypothyroidism===		===Primary (Central) Hypothyroidism===
	**Consider starting low dose [[levothyroxine]] at 25mcg daily		*Consider starting low dose [[levothyroxine]] at 25mcg daily
	**Close follow-up with primary care or endocrinology		*Close follow-up with primary care or endocrinology

	===Subclinical Hypothyroidism===		===Subclinical Hypothyroidism===
	**TSH ≥10 mU/L		*TSH ≥10 mU/L
	***Patients are at higher risk for atherosclerosis, myocardial infarction, and risk of progression to overt hypothyroidism		**Patients are at higher risk for atherosclerosis, myocardial infarction, and risk of progression to overt hypothyroidism
	***The American Thyroid Association (ATA), American Association of Clinical Endocrinologists (AACE) and the European Thyroid Association guidelines recommend initiating treatment<ref>Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid 2012; 22:1200.</ref><ref>Pearce SH, Brabant G, Duntas LH, et al. 2013 ETA Guideline: Management of Subclinical Hypothyroidism. Eur Thyroid J 2013; 2:215.</ref>		**The American Thyroid Association (ATA), American Association of Clinical Endocrinologists (AACE) and the European Thyroid Association guidelines recommend initiating treatment<ref>Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid 2012; 22:1200.</ref><ref>Pearce SH, Brabant G, Duntas LH, et al. 2013 ETA Guideline: Management of Subclinical Hypothyroidism. Eur Thyroid J 2013; 2:215.</ref>
	***Start low dose [[levothyroxine]] at 25mcg daily with close outpatient follow up		**Start low dose [[levothyroxine]] at 25mcg daily with close outpatient follow up

	**TSH 7.0 to 9.9 mU/L		*TSH 7.0 to 9.9 mU/L

	**TSH between upper limit of normal to 6.9 mU/L		*TSH between upper limit of normal to 6.9 mU/L

	==Disposition==		==Disposition==

Cdichang: /* Management */

2022-09-21T14:41:47Z

Management

← Older revision		Revision as of 14:41, 21 September 2022
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	*If treatment started, initiate low dose as daily doses too high may lead to [[thyroid storm]]		*If treatment started, initiate low dose as daily doses too high may lead to [[thyroid storm]]

	*Primary (Central) Hypothyroidism		===Primary (Central) Hypothyroidism===
	**Consider starting low dose [[levothyroxine]] at 25mcg daily		**Consider starting low dose [[levothyroxine]] at 25mcg daily
	**Close follow-up with primary care or endocrinology		**Close follow-up with primary care or endocrinology

	*Subclinical Hypothyroidism		===Subclinical Hypothyroidism===
	**TSH ≥10 mU/L		**TSH ≥10 mU/L
	***Patients are at higher risk for atherosclerosis, myocardial infarction, and risk of progression to overt hypothyroidism		***Patients are at higher risk for atherosclerosis, myocardial infarction, and risk of progression to overt hypothyroidism

Cdichang: /* Management */

2022-09-21T14:40:09Z

Management

← Older revision		Revision as of 14:40, 21 September 2022
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	**TSH ≥10 mU/L		**TSH ≥10 mU/L
	***Patients are at higher risk for atherosclerosis, myocardial infarction, and risk of progression to overt hypothyroidism		***Patients are at higher risk for atherosclerosis, myocardial infarction, and risk of progression to overt hypothyroidism
	***The American Thyroid Association (ATA), American Association of Clinical Endocrinologists (AACE) and the European Thyroid Association guidelines recommend initiating treatment		***The American Thyroid Association (ATA), American Association of Clinical Endocrinologists (AACE) and the European Thyroid Association guidelines recommend initiating treatment<ref>Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid 2012; 22:1200.</ref><ref>Pearce SH, Brabant G, Duntas LH, et al. 2013 ETA Guideline: Management of Subclinical Hypothyroidism. Eur Thyroid J 2013; 2:215.</ref>
	***Start low dose [[levothyroxine]] at 25mcg daily with close outpatient follow up		***Start low dose [[levothyroxine]] at 25mcg daily with close outpatient follow up

Cdichang: /* Management */

2022-09-21T14:37:39Z

Management

← Older revision		Revision as of 14:37, 21 September 2022
Line 89:		Line 89:
	==Management==		==Management==
	*Depends on etiology		*Depends on etiology
	**Consider starting [[levothyroxine]] daily		*If treatment started, initiate low dose as daily doses too high may lead to [[thyroid storm]]
	***~~Caution as daily doses too high may lead~~ to [[~~thyroid storm~~]]
			*Primary (Central) Hypothyroidism
			**Consider starting low dose [[levothyroxine]] at 25mcg daily
			**Close follow-up with primary care or endocrinology

			*Subclinical Hypothyroidism
			**TSH ≥10 mU/L
			***Patients are at higher risk for atherosclerosis, myocardial infarction, and risk of progression to overt hypothyroidism
			***The American Thyroid Association (ATA), American Association of Clinical Endocrinologists (AACE) and the European Thyroid Association guidelines recommend initiating treatment
			***Start low dose [[levothyroxine]] at 25mcg daily with close outpatient follow up

			**TSH 7.0 to 9.9 mU/L

			**TSH between upper limit of normal to 6.9 mU/L

	==Disposition==		==Disposition==

Rossdonaldson1: /* Categorization */

2019-12-17T22:36:35Z

Categorization

← Older revision		Revision as of 22:36, 17 December 2019
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	\| Tertiary\|\|Failure of hypothalamus		\| Tertiary\|\|Failure of hypothalamus
	\|}		\|}

			[[File:thyroid studies.JPG\|px200]]

	==Management==		==Management==