Management of Inadequately Treated Hypothyroidism

Diagnostic Evaluation

• The American College of Physicians recommends obtaining morning TSH and free T4 levels to assess adequacy of current replacement therapy, as fatigue and hair loss are classic manifestations of hypothyroidism, indicating insufficient levothyroxine dosing 1, 2, 3, 4, 5, 6
• High TSH with low free T4 confirms overt hypothyroidism requiring dose adjustment, according to the American Association of Clinical Endocrinologists 1, 2, 3, 4

Critical Pitfalls to Avoid

• The European Society of Endocrinology advises against screening for other autoimmune conditions or ordering extensive testing until adequate thyroid replacement is achieved, as many symptoms will resolve with proper dosing 7
• The American Thyroid Association recommends that if the patient has known or suspected adrenal insufficiency, corticosteroids must be started before increasing thyroid hormone to prevent adrenal crisis 1, 2, 3, 4, 8