Pregnancy: Raise the dose by 25–30% once pregnant; TSH every 4 wk in the first half, keep below 2.5 (ATA 2017, latest)
Subclinical (TSH under 10, normal T4): Usually no treatment; recheck in 3–6 months; treat if pregnant or planning pregnancy, or with goitre, TPO antibodies, heart disease or infertility (ICMR STW 2022; ETA 2013, latest)
Investigations
First visit
TSH and free T4 — Raised TSH with low free T4 is overt hypothyroidism.
Only if indicated
Anti-TPO antibodies — Subclinical hypothyroidism (predicts progression) or goitre.
Lipid profile — Baseline.
USG thyroid — Nodule or asymmetric goitre.
TSH in pregnancy — Planning pregnancy or pregnant — target under 2.5 in the 1st trimester.
Follow-up and monitoring
TSH 6–8 weeks after any dose change — Then every 6–12 months once stable.
Locked
The adult dose for each drug
Indian brand names for each drug, with a link to buy
ICU Decoded — original critical-care and internal-medicine pathways by
Dr Javed Akhtar, each cited to a current guideline. For education and quick
reference; verify every dose against local protocols before prescribing.