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Hypothyroidism, Adult

Faraz Ahmad, MD, MPH, Hiba Ahmad, PharmD and Christen D. Johnson, MD, MPH Reviewed 06/2020
 


BASICS

DESCRIPTION

  • Clinical and metabolic state resulting from decreased levels of free thyroid hormone or from resistance to hormone action

  • Primary (intrinsic thyroid disease) or central (secondary or ...

DIAGNOSIS

HISTORY

Symptoms can vary and can be nonspecific. 
  • Lethargy

  • Fatigue

  • Cold intolerance

  • Slowed thinking

  • Hearing impairment

  • Constipation

  • Dry skin

  • Muscle cramps, arthralgias, paresthesias

  • Modest weight gai...

TREATMENT

MEDICATION

First Line

  • Levothyroxine (Synthroid, Levothroid)

    • 1.5 to 1.8 μg/kg/day (use ideal body weight) (2)[A]; titrate by 12.5 to 25.0 μg/day every 4 to 8 weeks until TSH in normal range.

    • Dosa...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Monitor TSH and free T4 every 4 to 8 weeks after initiating treatment or after change in dose. Once stabilized, periodic TSH level should be don...

REFERENCES

1
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 Thyro...

CODES

ICD10

  • E03.9 Hypothyroidism, unspecified

  • E06.3 Autoimmune thyroiditis

  • E89.0 Postprocedural hypothyroidism

  • E05.10 Thyrotxcosis w toxic sing thyroid nodule w/o thyrotxc crisis

  • E05.21 Thyrotxcosis w toxi...

CLINICAL PEARLS

  • Screening test: TSH levels; Serum free T3 or total T3 should not be done to diagnose hypothyroidism (1)[A].

  • Monitor TSH and free T4 every 4 to 8 weeks after initiating treatment or afte...

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