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>18</sup>
By vgreene, 28 May, 2015 If sx persist<sup>17</sup> despite normal TSH: acknowledge sx, eval for alternative causes [W/L]. Follow sx (cold sensitivity, dry skin, fatigue, ↑ wt, puffiness, constipation, etc), but sx alone lack sensitivity/specificity [W/L]
By vgreene, 28 May, 2015 If obesity/depression/dyslipidemia/athyreosis:<sup>16</sup> insufficient evidence of benefit to recommend aiming for low-NL TSH or high-NL T3 levels<sup>13</sup> [S/M]
By vgreene, 28 May, 2015 Adjust dose if large wt Δ, ✓ TSH 4-6 wks post dose change [S/M]. If dose higher than expected, eval/tx GI disorders<sup>15</sup>
By vgreene, 28 May, 2015 Re-✓ TSH if change in product<sup>15</sup> (brand or generic) [W/L], if start/stop estrogen or androgen; or if start TKIs, phenobarbital, phenytoin, carbamazepine, rifampin, sertraline [S/L]
By vgreene, 28 May, 2015 Infants: Maintain serum thyroxine in mid-to-upper ½ of pedi ref range, TSH in mid-to-lower ½ of pedi ref range. Aim to normalize serum T4 by ≈2-4 wks post tx start [S/H]
By vgreene, 28 May, 2015 ✓ TSH @ steady state; ✓ TSH/T4 q1-2mo during 1st yr of life, ↓ frequency w/ age [S/H]. If 2° hypothyroidism:<sup>14</sup> follow T4
