American Thyroid Association Quick-Reference GUIDELINES Apps
Issue link: https://eguideline.guidelinecentral.com/i/521958
3 Î The adverse effects of thyroid hormone deficiency include detrimental effects on the serum lipid profile and progression of cardiovascular disease. The ATA recommends that patients with overt hypothyroidism be treated with doses of levothyroxine that are adequate to normalize serum TSH levels, in order to reduce or eliminate these undesirable effects. (S-M) Î Perceived allergy or intolerance to levothyroxine can be managed by changing the dose or product, including consideration of gel capsules, and possibly by treating concomitant iron-deficiency anemia. In selected cases, a consultation with an allergist may be appropriate. (W-L) Î The ATA recommends considering patients' underlying medical conditions (such as atherosclerotic heart disease) in order to establish realistic treatment goals and avoid exacerbation of underlying comorbidities. (W-L) Î The treatment goals of hypothyroidism are the same for patients with psychosocial, behavioral, and mental health conditions as for the general population. However, referral to a mental health professional should be considered if the severity of the symptoms is not sufficiently explained by the severity of the biochemically confirmed thyroid dysfunction or another medical condition, or if the mental health condition is impairing effective management of levothyroxine replacement therapy. (S-L). Î In older patients, levothyroxine should generally be initiated with low doses, and the dose titrated slowly based on serum TSH measurements. It should be recognized that normal serum TSH ranges are higher in older populations (such as those >65 years) and that higher serum TSH targets may be appropriate. (S-M) Î If prescription of daily levothyroxine is not successful in maintaining a normal serum TSH, weekly oral administration of the full week's dose of levothyroxine should be considered in individuals in whom adherence cannot otherwise be sustained. (W-L) Î There is insufficient evidence of benefit to recommend that treatment with levothyroxine be targeted to achieve low-normal TSH values or high-normal triiodothyronine values in patients with hypothyroidism who are overweight, those who have depression or dyslipidemia, or those who are athyreotic. (S-M)