Algorithmic Approach to Hypothyroidism - Differential Diagnosis and Management Framework
Central Hypothyroidism (Secondary or tertiary) ↓TSH, ↓FT4
• Post-GH therapy, drug-induced
• Pituitary adenoma
• Craniopharyngioma
• Meningioma
• Glioma
• Germinoma
• Immunologic lesions
Overt Hypothyroidism ↑TSH, ↓FT4
• Initiate LT4
≤ 65 yo; no CVD: 1.6 μg/kg daily
> 65 yo or CVD: 12.5-25 μg daily
• Measure TSH in 4-6 weeks, Titrate LT4 based on TSH
Subclinical Hypothyroidism ↑TSH, ↔FT4
• Recheck TSH after 2-3 months and obtain TPOAb
Euthyroid sick syndrome ↔TSH, ↓FT3/↓FT4
• Treat acute illness
Matthew Ho, MD PhD @MatthewHoMD
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