Prepared by: Ph.

Bashair Aldossari

The Hypothyroidism Treatment Algorithm

Hypothyroidism

Overt or Primary Hypothyroidism Subclinical Hypothyroidism

High TSH + Low T4 High TSH + Noraml T4

Give the patient Levothyroxine or Without

With syptoms
Liothyronine or both of them based on symptoms
the patient situation and adjust the
dose every 6-8 weeks except pregnant
women and infent should be Give the patient Levothyroxine or
Don't start the treatment and monitor the
monitoring every 4 weekss. Liothyronine based on his/her situation and
patinet except the infant and the pregant
women should be trated even if they don't adjust the dose every 6-8 weeks except
have any symptoms. pregnant women and infent should be
monitoring every 4 weekss.

NOTE: The converting from Levothyroxine to Liothyronine is 20-25mcg from Liothyronine will be equal to 100mcg
of Levothyroxine.

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 Prepared by: Ph. Bashair Aldossari

Category Dose NOTE

Adult without IHD and other
cardiovascular disease like HF,MI…
etc.
ü 1.6-1.7 mcg/kg/day based on
IBW if Obese patient.
OR
ü Initially, we start with 50-
100mcg once per day.
ü The maintenance dose is 100-
200mcg once per day.

Adult (elderly patient) with IHD and ü Initially, 12.5-25 mcg once per The increasing of dose should be
other cardiovascular disease like day. 12.5-25 mcg daily every 2-6 weeks.
HF,MI… etc. ü Adjust the dose based on
patient symptoms and lab
results.
Pregnant women  Treat even mildly elevated TSH values.
 Increase T4 replacement by 30% with first detection of pregnancy.
 If the patient already has hypothyroidism before becoming pregnant
then once she becomes pregnant increase the dose from 40% up to
50% of her previous dose.
Infants 10–15 mcg/kg/day  Can crush & mix with formula or
breast milk
 Monitor with TFT values for first
6 months of life and follow up
the patient every 4 weeks.

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 Prepared by: Ph. Bashair Aldossari

The Hyperthyroidism Treatment Algorithm

Hyperthyroidism

Overt or Primary Hyperthyroidism Subclinical Hyperthyroidism

Low TSH + High T3 +/- T4 Low TSH + Noraml T3 + T4

Without symptoms With syptoms

Start the treatment

Start the
Don't start the treatment and monitor the patinet except the infant and treatment
the pregant women should be trated even if they don't have any
symptoms.

The treatment choices for hyperthyroidism:

1. Thioamide: Methimazole and propylthiouracil (PTU).
2. Radioactive iodine.
3. Surgery.

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Prepared by: Ph. Bashair Aldossari

pg. 4