메뉴
Determines levothyroxine dosing for central hypothyroidism to achieve serum free T4 in the mid to upper half of the reference range. Triggers include confirmed central hypothyroidism requiring thyroid hormone replacement when initiating L‑4 therapy.
기본적으로 소스를 먼저 확인하는 Prompt가 선택됩니다. 직접 명령으로 전환하거나 로컬 사본을 다운로드할 수도 있습니다.
설치 여부를 결정하기 전에 SKILL.md와 SkillsMP에 표시된 보조 파일을 읽어 보세요.
Codex 또는 Claude로 설치 이 Prompt를 복사해 Codex, Claude 또는 다른 어시스턴트에 붙여 넣으면 Skill 페이지를 검토하고 설치를 진행할 수 있습니다.
직접 명령은 검토 Prompt를 거치지 않습니다. 실행하기 전에 소스를 확인하세요.
npx skills add https://github.com/dromlakhani/MD2SKILL --skill ata-lt4-dosing-ch명령은 한 줄로 유지됩니다. 복사하기 전에 가로로 스크롤해 전체 내용을 확인하세요.
로컬 사본을 원하시나요? SkillsMP에서 현재 제공할 수 있는 파일을 다운로드하세요.
For a person with confirmed islet autoantibodies (early-stage type 1 diabetes), state the numerical progression risk to Stage 3 T1D by stage and age, set the age-stratified monitoring frequency (metabolic and HbA1c), apply the ≥10% longitudinal HbA1c rise → OGTT rule, and give the standard risk-modifier and communication framing. Use when a clinician asks how often should I monitor this Stage 1 child, what's the risk of this teenager progressing to insulin, adult with GAD positive what's the 5-year risk, my patient's HbA1c has risen 12% is that important, single autoantibody how often to retest, or how to counsel a family about progression risk. Grounded in Phillip et al. Diabetologia 2024 international staging and monitoring consensus, cross-referenced with Hussain et al 2026 IDF Europe roadmap.
Order and confirm islet autoantibody screening for early-stage type 1 diabetes — which antibodies to test (GAD65, IAA, IA2, ZnT8), sample types (capillary dried blood spot, venous), the mandatory two-sample two-method confirmation protocol, and how to interpret a positive, negative, or single-antibody result. Use when a clinician asks how to screen for early T1D, which islet autoantibodies to order, how to confirm a positive T1D antibody screen, is one autoantibody enough for T1D diagnosis, GAD antibody positive what next, or is running a general population or family-history T1D screening program. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
Classify a person with a positive islet autoantibody screen into a specific stage of type 1 diabetes (At Risk / Stage 1 / Stage 2a / Stage 2b / Stage 3a / Stage 3b / Stage 4) using the international consensus staging framework based on autoantibody count and glycaemic status. Use when a clinician asks how to stage a positive autoantibody screen, what stage of T1D is this, is this early-stage T1D, does this child need insulin yet, is this presymptomatic T1D, does this qualify for teplizumab, or presents a person with any combination of islet autoantibodies + glucose data. Applies across paediatric and adult populations. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
SOC 직업 분류 기준
SKILL.md 표시 중
| name | ata-lt4-dosing-ch |
| description | Determines levothyroxine dosing for central hypothyroidism to achieve serum free T4 in the mid to upper half of the reference range. Triggers include confirmed central hypothyroidism requiring thyroid hormone replacement when initiating L‑4 therapy. |
Confirm central hypothyroidism: low serum fT4 with low, normal, or mildly elevated TSH in the setting of pituitary disease. Assess for adrenal insufficiency (morning cortisol, ACTH stimulation test if indeterminate). Record patient weight, age, clinical context (pregnancy, estrogen therapy, GH replacement), and baseline fT4.
Rule out adrenal insufficiency before starting L‑T4. If AI is confirmed or cannot be excluded, initiate empiric glucocorticoid replacement and defer L‑T4 until AI is evaluated; if AI is ruled out, proceed to dose calculation.
Calculate initial L‑T4 dose: weight (kg) × 1.6 μg/kg/d. Adjust upward for pregnancy, estrogen therapy, or GH replacement; adjust downward for age >60 years or comorbidities that increase overtreatment risk. Target fT4 in the mid‑upper half of the reference range. Use this dose as the starting point for L‑T4 therapy.
Prescribe the calculated L‑T4 dose (rounded to nearest 25 μg increment). Schedule serum fT4 re‑evaluation in 6–8 weeks and adjust dose by 12.5–25 μg increments to maintain fT4 within target range.
Do not use TSH to guide L‑T4 dosing in central hypothyroidism. Avoid L‑T3, thyroid extracts, or other formulations. Ensure adrenal insufficiency is evaluated prior to L‑T4 initiation to prevent adrenal crisis. Monitor for signs of over‑replacement (elevated fT4, tachycardia, weight loss) and under‑replacement (persistent hypothyroid symptoms, low fT4).
A 60‑kg, 55‑year‑old woman with confirmed central hypothyroidism, no adrenal insufficiency, not pregnant or on estrogen, and not on GH replacement. Initial dose: 60 × 1.6 = 96 μg/d → round to 100 μg L‑T4 daily. Recheck fT4 at 6 weeks; if fT4 is low‑mid, increase to 112.5 μg; if high‑mid, decrease to 87.5 μg.
Source: Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, DOI:10.1210/jc.2016-2118
TODO: consider adding scripts/calc.py for the ata-lt4-dosing-ch calculator