Symptom Grade

Grade 1

Asymptomatic; clinical or diagnostic observations only; intervention not indicated

Grade 2

Symptomatic; thyroid suppression therapy indicated; limiting instumental ADL

Grade 3

Severe symptoms; limiting self-care
ADL; hospitalization indicated

Grade 4

Life treatening consequences; urgent intervention indicated

Management escalation pathway

Persue ICPI

Start standard thyroid replacement therapy: initial dose can be the full dose (1.6 mcg/kg) in young, healthy patients, but a reduced dose of 25 -50mcg should be initiated in elderly patients with known cardiovascular disease.



Restart when downgraded to grade 2 Same as grade 2



ADL: Activities of Daily Living
ICPi: Immune Checkpoint Blockade Inhibition
TSH: Thyroid-Stimulating Hormone
T4: Thyroxine 4