Representative case |
Elderly patients |
Women related to pregnancya
|
All other cases |
|
Main policy of management |
Wait-and-see |
Consider LT4-Tx |
Case by case (mainly, wait-and-see) |
|
UNL of TSH |
If possible, use the population-based, age-specific ULN |
If possible, use the population-based, trimester (TM)-specific ULN (during pregnancy) |
If possible, use the population-based, age-specific ULN |
|
If unavailable, TSH 4–9.9 mIL/L (grade 1) TSH ≥10 mIL/L (grade 2) |
If unavailable, (during pregnancy) 1st TM 0.1–2.5 mIL/L 2nd TM 0.3–3.0 mIL/L 3rd TM 0.3–3.0 or 3.5 mIL/L |
If unavailable, TSH 4–9.9 mIL/L (grade 1) TSH ≥10 mIL/L (grade 2) |
|
Follow-up schedule of TFT |
Go slow (3–6 months) |
Could be a tight schedule depending on LT4-Tx |
Case by case (mainly, go slow: 3–6 months) |
|
Exceptions |
(may) Consider LT4-Tx trial in less old (65–75 years), non-frail, grade 2, progressive case, risk of CVD (e.g., heart failure), and patient’s willing |
(may) Consider ‘wait-and-see’ without LT4-Tx in case of transient sHypo, mild sHypo in third trimester, women under birth control |
(may) Consider LT4-Tx trial in progressive cases, large goiter, grade 2, positive TPOAb, CVD risks, genetic causes (children) and patients’ willing |
|
LT4-Tx |
Start with lower than usual dosage (12.5–25 μg/day) and tighter schedule of TFT |
Could start with higher dosage than usual, if needed |
Start with lower or usual dosage (50–100 μg/day) and tighter schedule of TFT |
|
Duration of LT4-Tx |
No definite criteria (6 months trial and re-evaluation) |
Up to the end-point of pregnant issue |
No definite criteria (6 months trial and re-evaluation) |
|
Education |
In case of CAT, education about the iodine restriction is essential, especially iodine replete area.
In women of child-bearing age, education about the necessity of planned pregnancy is essential.
In wait-and-see cases, education about the symptoms of hypothyroidism would be needed not to miss the overt hypothyroidism.
In LT4-Tx cases, education about the symptoms of hyperthyroidism would be needed not to miss the overtreatment.
|