By vgreene, 28 May, 2015 If >65-70 yo w/o known heart dz or major heart dz risk factors: can start full dose, though some prefer starting low, increasing slowly
By vgreene, 28 May, 2015 Initiate full replacement or partial w/ gradual up-titration per TSH [S/M]. In older pts: start low, titrate slowly; higher TSH target may be appropriate [S/M]
By vgreene, 28 May, 2015 Base start dose on age, wt, lean body mass, hypothyroidism etiology, TSH level, clinical context (eg, cardiac dz); consider TSH goal appropriate for clinical situation [S/M]
By vgreene, 28 May, 2015 If subclinical hypothyroidism in children: many consider it reasonable to start tx to avoid growth/development impact
By vgreene, 28 May, 2015 If subclinical hypothyroidism w/ TSH >10 mIU/L, s/sx consistent w/ primary thyroid dz, and/or risk factors assoc. w/ progression: levothyroxine tx may be reasonable [W/L]
By vgreene, 28 May, 2015 Time dose consistently either 60 min prebreakfast or at bedtime (≥3 hr after evening meal) [W/M]; separate from potentially interfering meds/supplements (eg, Ca carbonate, FeSO4);<sup>4</sup> 4-hr separation traditional but untested [W/W]
By vgreene, 28 May, 2015 Infants: 10-15 mcg/kg/day once newborn screening (+), pending confirmatory tests; higher doses may be required if severe congenital hypothyroidism [S/H]
