What are the steps for a hypothyroidism (underactive thyroid) workup based on Clinical Practice Guidelines (CPG)?

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Hypothyroidism Workup Based on Clinical Practice Guidelines

The initial workup for hypothyroidism should include measurement of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels, as these are the essential laboratory tests for diagnosis. 1, 2

Initial Laboratory Testing

  • TSH is the preferred test for initial evaluation of suspected primary hypothyroidism, with an elevated TSH level almost always signaling primary hypothyroidism 2
  • Both TSH and FT4 should be measured simultaneously in symptomatic patients to properly distinguish between primary and central hypothyroidism 1
  • Low TSH with low FT4 is consistent with central hypothyroidism (pituitary or hypothalamic origin) and requires further evaluation 1
  • Normal TSH with low FT4 may indicate non-thyroidal illness or assay interference 3

Diagnostic Criteria

  • Primary hypothyroidism: Elevated TSH with low FT4 (overt) or normal FT4 (subclinical) 4
  • Overt hypothyroidism: TSH > 4.5 mIU/L with FT4 below reference range 1, 3
  • Subclinical hypothyroidism: TSH > 4.5 mIU/L with normal FT4 4, 3
  • Central hypothyroidism: Low or inappropriately normal TSH with low FT4 1

Additional Testing When Indicated

  • Consider thyroid peroxidase (TPO) antibodies to identify autoimmune thyroiditis (Hashimoto's), which is the most common cause of primary hypothyroidism 5
  • In cases of suspected central hypothyroidism, evaluate other pituitary hormones, especially the hypothalamic-pituitary-adrenal axis 4
  • Morning ACTH and cortisol levels should be checked if central hypothyroidism is suspected, as hypocortisolism needs to be corrected before initiating thyroid hormone replacement 4
  • TSH receptor antibody testing if there are clinical features suggesting Graves' disease 1

Special Considerations

  • For pregnant women or those planning pregnancy, thyroid function should be evaluated promptly as hypothyroidism increases risk of pregnancy complications and impaired cognitive development in offspring 4
  • In patients with persistent symptoms despite apparently adequate replacement therapy, check for poor compliance, malabsorption, or drug interactions 4
  • For elderly patients (>70 years), consider a more conservative approach to treatment of subclinical hypothyroidism 4

Treatment Initiation

  • All patients with overt hypothyroidism should be treated with levothyroxine 3
  • Subclinical hypothyroidism with TSH >10 mIU/L should be treated 4
  • For subclinical hypothyroidism with TSH ≤10 mIU/L, treatment should be considered in:
    • Symptomatic patients
    • Patients with infertility
    • Patients with goiter or positive TPO antibodies 4
    • Pregnant women or women planning pregnancy 4

Levothyroxine Dosing

  • For most young patients without comorbidities, full calculated dose can be started at approximately 1.6 mcg/kg/day 1, 6
  • For patients >70 years old, frail patients, or those with coronary artery disease, start with lower doses (25-50 mcg/day) and titrate gradually 1, 7
  • For patients with severe, long-standing hypothyroidism, start with lower doses to avoid precipitating cardiac events 4

Monitoring and Follow-up

  • Monitor TSH levels 6-8 weeks after initiating treatment or changing dose 6, 5
  • Target TSH for primary hypothyroidism is 0.5-2.0 mIU/L 4
  • For central hypothyroidism, monitor free T4 levels, which should be maintained in the upper half of the normal range 4
  • Once stable, monitor TSH annually to avoid overtreatment or undertreatment 5

Common Pitfalls to Avoid

  • Failing to check both TSH and FT4 in symptomatic patients, which can miss central hypothyroidism 1
  • Starting full replacement doses in elderly patients or those with cardiac disease, which can precipitate arrhythmias or ischemia 4, 7
  • Overreplacement with levothyroxine, which increases risk of atrial fibrillation and osteoporosis 4
  • Not considering drug interactions or absorption issues in patients with persistently elevated TSH despite adequate replacement doses 4
  • Failing to evaluate the hypothalamic-pituitary-adrenal axis in suspected central hypothyroidism before starting thyroid hormone replacement 4

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Hypothyroidism.

Annals of internal medicine, 2020

Research

Hypothyroidism: A Review.

JAMA, 2025

Research

Hypothyroidism: Diagnosis and Treatment.

American family physician, 2021

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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