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Hypothyroidism, Adult

Faraz Ahmad, MPH, MD, Hiba Ahmad, PharmD, BCOP and Kirubel Zeleke, Medical Degree Reviewed 05/2023
 


BASICS

DESCRIPTION

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

  • Classified as primary, central or peripheral based on patholo...

DIAGNOSIS

HISTORY

Symptoms can vary and can be nonspecific. 
  • Lethargy, fatigue

  • Cold intolerance

  • Constipation

  • Dry skin

  • Muscle cramps, arthralgias, paresthesias

  • Modest weight gain (4-11 lbs [2-4.5 kg])

  • Menstrua...

TREATMENT

MEDICATION

First Line

  • Levothyroxine (Synthroid, Levothroid)

    • 1.5 to 1.8 μg/kg/day (use ideal body weight) (3)[A]; titrate by 12.5 to 25 μg/day every 4 to 8 weeks until TSH in normal range.

    • Dosag...

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
Chaker L, Razvi S, Bensenor IM,
et al
2
. Hypothyroidism. Nat Rev Dis Primers. 2022;8(1):30. doi: 10.1038/s41572-022-00357-7. Erratum in: Nat Rev Dis Primers. 2022;8(1):39. PMID: 35589725.
3
...

CODES

ICD10

  • E03.9 Hypothyroidism, unspecified

  • E06.3 Autoimmune thyroiditis

  • E89.0 Postprocedural hypothyroidism

  • E06.3 Autoimmune thyroiditis

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

CLINICAL PEARLS

  • Screening test: Order TSH levels; serum free T4 should be obtained only if TSH is abnormal and not as part of initial screening test (2)[A].

  • Monitor TSH and free T4 every 4 to 8 weeks ...

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