A 36 year old female comes to the ED reporting worsening fatigue. She has a history of hypothyroid admits she has not been taking her levothyroxine for the last several months due to missing follow up appointments. She is alert, answering questions appropriately and has normal vital signs. What is the best management plan? (scroll down for the answer)

a) Admit for monitoring with endocrinology consultation

b) Give 500mcg IV thyroxine now and admit to the hospital

c) Restart patient at her prior levothyroxine dose with outpatient endocrinology follow up

d) Restart patient at 50mcg/day levothyroxine, can be titrated up to prior dosing as outpatient. Outpatient endocrinology follow up

The correct answer is c) Restart patient on her prior levothyroxine dose. Outpatient follow up is appropriate.   

Uncomplicated hypothyroidism can be managed as an outpatient. The patient does not require a slow titration up to prior doses.

500mcg IV thyroxine is the appropriate treatment if the patient were in a myxedema come (300-500 mcg are recommended)

See our prior flow sheet on the topic here: http://emdaily.cooperhealth.org/content/back-basics-symptomatic-hypothyr...

References:

¹ Stapczynski, J. Stephan,, and Judith E. Tintinalli. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York, N.Y.: McGraw-Hill Education LLC., 2011.