Hypocalcemia Surveillance, Total Thyroidectomy — For Patients Requiring Thyroid Hormone Replacement — Clinical Pathway: Inpatient and Outpatient Specialty Care

Thyroidectomy Calcium Management Clinical Pathway — Inpatient and Outpatient Specialty Care

For Children Requiring Thyroid Hormone Replacement

Children will be discharged on one of these two thyroid medications, Levothyroxine (L-T4) or Liothyronine (L-T3). To determine which is indicated for the child, refer to endocrine team
on call.

Levothyroxine (L-T4) is longer-acting and is the most commonly used hormone replacement
in children with post-surgical hypothyroidism. Repeat TFTs will be arranged by the Thyroid
Center Team.

Suggested Dose Selection

Age Weight-based Dose Typical Dose
3-6 mos 8-10 mcg/kg 25-50 mcg
6-12 mos 6-8 mcg/kg 25-50 mcg
1-5 yrs 5-6 mcg/kg 25-50 mcg
6-12 yrs 4-5 mcg/kg 50-100 mcg
12-16 yrs 2-3 mcg/kg 75-150 mcg
> 16 yrs 1.6 mcg/kg 100-200 mcg

Liothyronine (L-T3)

Short-acting; should be used in children with suspected differentiated thyroid cancer who will receive radioactive iodine ablation in several weeks. Consult Pediatric Thyroid Center to schedule follow-up.

  Dose Frequency
Prepubertal 5-15 mcg/dose Give 2x/day
Pubertal 20-25 mcg/dose Give 2x/day