Management of Hypothyroidism

Common causes of hypothyroidism include:

  • Thyroiditis (commonly Hashimoto’s thyroiditis)
  • Iodine deficiency
  • Thyroidectomy
  • Radioiodine ablation
  • Drug induced hypothyroidism
  • Congenital hypothyroidism

Treating with Levothyroxine1

‡ The AACE, ATA and TES Consensus statement on subclinical thyroid dysfunction indicates that, in presence of TSH between 4.5 and 10 mlU/L and symptoms of hypothyroidism, the clinical judgement of the healthcare provider should be the key determining factor in considering treatment.

Use TSH testing to monitor levothyroxine treatment

Patients being treated for hypothyroidism should have their serum TSH measured:2

  • 4 to 8 weeks after initiating treatment
  • After 6 months and then at 12-month intervals after an adequate replacement dose has been determined
  • After a change in dose
  • More frequently depending on the clinical situation

Treatment target range2

If upper and lower normal TSH values are not available in the laboratory, the range of 0.45 to 4.12 mlU/L should be employed.

References:

  1. 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 Thyroid Association Endocr Pract. 2012;18(6):988-1028.
  2. 2. AACE and ATA Taskforce on Hypothyroidism in Adults. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid 2012; 22(12):1200-35.