By vgreene, 28 May, 2015 If nonadherent w/ abnl TSH: consider weekly oral administration of full week’s dose [W/L]
By vgreene, 28 May, 2015 If perceived allergy/intolerance to levothyroxine: change dose/product<sup>30</sup>
By vgreene, 28 May, 2015 If sx persist<sup>29</sup> despite normal TSH: acknowledge sx, eval for alternative causes [W/L]. Follow sx (cold sensitivity, dry skin, fatigue, ↑ wt, puffiness, constipation, etc.) but alone, sx lack sensitivity/specificity [W/L]
By vgreene, 28 May, 2015 Normalize trimester-specific TSH,<sup>25,26</sup> avoid iatrogenic thyrotoxicosis [S/M]
By vgreene, 28 May, 2015 Adjust dose if large wt Δ, aging; ✓ TSH 4-6 wks post dose-change [S/M]. If dose higher than expected, eval/tx GI disorders<sup>26</sup>
By vgreene, 28 May, 2015 If obesity/depression/dyslipidemia/athyreosis:<sup>28</sup> insufficient evidence of benefit to recommend aiming for low-NL TSH or high-NL T3 levels [S/M]<sup>25</sup>
By vgreene, 28 May, 2015 Re-✓ if change in product<sup>27</sup> (brand or generic) [W/L], or if start/stop estrogen or androgen; or if start TKIs, phenobarbital, phenytoin, carbamazepine, rifampin, sertraline [S/L]
By vgreene, 28 May, 2015 Titrate dose to achieve trimester-specific TSH, ✓ TSH q4wks during 1st half of pregnancy, then reassess during 2nd half [S/M]
By vgreene, 28 May, 2015 If pregnant already on levothyroxine: give 1 extra dose (of current dose) twice weekly (several days apart) as soon as pregnancy confirmed [S/M]
