Evaluation of Hypothyroidism - Flowchart

Evaluation of Hypothyroidism - Flowchart

Evaluation of Hypothyroidism - Flowchart

«Flowchart»

Measure TSH

Measure TSH

Measure TSH

Elevated

Elevated

Elevated

Normal

Normal

Normal

No further tests

No further tests

No further tests

T₄ treatment

T₄ treatment

T₄ treatment

₄

Annual follow-up

Annual follow-up

Annual follow-up

Autoimmune hypothyroidism

Autoimmune hypothyroidism

Autoimmune hypothyroidism

Rule out other causes of hypothyroidism

Rule out other causes of hypothyroidism

Rule out other causes of hypothyroidism

Rule out drug effects, sick euthyroid syndrome, then evaluate anterior pituitary function

Rule out drug effects, sick euthyroid syndrome, then evaluate anterior pituitary function

Rule out drug effects, sick euthyroid syndrome, then evaluate anterior pituitary function

T₄ treatment

T₄ treatment

T₄ treatment

₄

No further tests

No further tests

No further tests

End

End

End

Pituitary disease suspected?

Pituitary disease suspected?

Pituitary disease suspected?

Yes

Yes

Yes

No

No

No

Measure unbound T₄

Measure unbound T₄

Measure unbound T₄

₄

Low

Low

Low

Normal

Normal

Normal

Measure unbound T₄

Measure unbound T₄

Measure unbound T₄

₄

Normal

Normal

Normal

Low

Low

Low

Mild hypothyroidism

Mild hypothyroidism

Mild hypothyroidism

TPOAb⁺ or symptomatic

TPOAb⁺ or symptomatic

⁺ TPOAb[+]

TPOAb^–, no symptoms

TPOAb^–, no symptoms

^– TPOAb[-]

Primary hypothyroidism

Primary hypothyroidism

Primary hypothyroidism

TPOAb⁺

TPOAb⁺

⁺ TPOAb[+]

TPOAb^–

TPOAb^–

^– TPOAb[-]