Monitor stable patients annually, especially the elderly
Examine the patient and measure serum TSH annually after identifying the proper maintenance dose, more often if an abnormal result or a change in the patient’s status occurs.2 Certain situations such as pregnancy, initiation of new medications, or liver or kidney disease may require more frequent monitoring.
Generally, once a stable maintenance dosage of levothyroxine is achieved, the dosage will remain adequate until the patient has a significant weight change or reaches his or her seventh or eighth decade.1 Although monitoring less often than once a year can be justified in younger adult patients whose weight is stable, patients older than 65 years must be monitored annually to avoid overreplacement. With age, thyroid binding may decrease, and the serum albumin level may decline. This can result in a 20% reduction in the dose of levothyroxine required.5,6
Recommendations
The American Association of Clinical Endocrinologists (AACE) recommends reassessment and repeat lab work at least 6 weeks after any change in levothyroxine brand or dose. The AACE practice guidelines suggest follow-up with appropriate interim history, physical exam, and pertinent lab studies at 6 months, and then annually after the TSH level has normalized.7